Index Admission Cholecystectomy and Recurrence of Pediatric Gallstone Pancreatitis: Multicenter Cohort Analysis.

Creator(s)

Armando S. Muñoz Abraham
Hector Osei
Adam Baijinting
Robert A. Cowles
Jose Greenspon
Brain D. Hosfield
Martin S. Keller
Matthew P. Landman
Hawkins Owens
Matthew P. Shaughnessy
Shawn D. St Peter, Children's Mercy HospitalFollow
Joseph Sujka, Children's Mercy Hospital
Adam M. Vogel
Gustavo A. Villalona

Document Type

Article

Publication Date

3-1-2022

Identifier

DOI: 10.1097/XCS.0000000000000062

Abstract

BACKGROUND: We aim to evaluate recurrence rates of gallstone pancreatitis in children undergoing early vs interval cholecystectomy.

STUDY DESIGN: A multicenter, retrospective review of pediatric patients admitted with gallstone pancreatitis from 2010 through 2017 was performed. Children were evaluated based on timing of cholecystectomy. Early cholecystectomy was defined as surgery during the index admission, whereas the delayed group was defined as no surgery or surgery after discharge. Outcomes, recurrence rates, and complications were evaluated.

RESULTS: Of 246 patients from 6 centers with gallstone pancreatitis, 178 (72%) were female, with mean age 13.5 ± 3.2 years and a mean body mass index of 28.9 ± 15.2. Most (90%) patients were admitted with mild pancreatitis (Atlanta Classification). Early cholecystectomy was performed in 167 (68%) patients with no difference in early cholecystectomy rates across institutions. Delayed group patients weighed less (61 kg vs. 72 kg, p = 0.003) and were younger (12 vs. 14 years, p = 0.001) than those who underwent early cholecystectomy. However, there were no differences in clinical, radiological, or laboratory characteristics between groups. There were 4 (2%) episodes of postoperative recurrent pancreatitis in the early group compared with 22% in the delayed group. More importantly, when cholecystectomy was delayed more than 6 weeks from index discharge, recurrence approached 60%. There were no biliary complications in any group.

CONCLUSIONS: Cholecystectomy during the index admission for children with gallstone pancreatitis reduces recurrent pancreatitis. Recurrence proportionally increases with time when patients are treated with a delayed approach.

Journal Title

Journal of the American College of Surgeons

Volume

234

Issue

3

First Page

352

Last Page

358

Recommended Citation

Muñoz Abraham AS, Osei H, Baijinting A, et al. Index Admission Cholecystectomy and Recurrence of Pediatric Gallstone Pancreatitis: Multicenter Cohort Analysis. J Am Coll Surg. 2022;234(3):352-358. doi:10.1097/XCS.0000000000000062