Medium-term results after cholecystectomy in patientsyounger than 10 years

Mattioli, Girolamo; Repetto, P.; Carlini, Claudio; Granata, Claudio; Montobbio, Giovanni; Cagnazzo, A.; Barabino, A.; Gandullia, Paolo; Jasonni, Vincenzo

doi:10.1007/s00464-001-9029-2

Cited by 12 publications

(10 citation statements)

References 16 publications

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“…Surgical options for pediatric cholelithiasis include open or laparoscopic cholecystectomy [8] . At the present, laparoscopic technique is considered the gold standard for cholecystectomy in children for reduced pain, absence of an upper abdominal incision and scar formation and a shorter period of hospitalization [9][10][11][12] . The non-surgical approach is based on the use of ursodeoxycholic acid (UDCA); UDCA can reduce cholesterol saturation in bile and progressively dissolve cholesterol gallstones [13,14] .…”

Section: Resultsmentioning

confidence: 99%

Management of cholelithiasis in Italian children: A national multicenter study

Corte¹,

Falchetti²,

Nebbia³

et al. 2008

WJG

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development of complications was reported. CONCLUSION:The therapeutic strategies were extremely heterogeneous. Ursodeoxycholic acid was ineffective in dissolution of gallstones but it had a positive effect on the symptoms. Laparoscopic cholecystectomy was confirmed to be an efficacy and safe treatment for pediatric gallstones. INTRODUCTIONIn the last years following the extensive use of ultrasound scanning an increasing number of children with cholelithiasis has been identified. In a population based study, prevalence of gallstones and biliary sludge in children was of 1.9% and 1.46%, respectively [1] . In an analogue study, performed in Italian adults, the overall prevalence of gallstones diseases was of 9.5% in men and 18.9% in women [2] . Gallstones disease is the most common and costly of all digestive disease in the United States, resulting in 700 000 cholecystectomies and as many as 1 000 000 hospitalizations annually [3] . The frequency of hospital admission and operation for gallstones increased in Western countries since the 1950s [4] . In England the age-standardized hospital admission rate for cholelithiasis enhanced from 68.7 to 104.9 per 100 000 population between 1989/1990 and 1999/2000 and it increased progressively with age from 1.1 per 100 000 in the 0-14 year age group to 277.1 per 100 000 in the ≥ 85-year age group in 1999/2000 [5] . Guidelines for management of cholelithiasis are available for adults. Cholecystectomy is recommended for

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Section: Resultsmentioning

confidence: 99%

Management of cholelithiasis in Italian children: A national multicenter study

Corte¹,

Falchetti²,

Nebbia³

et al. 2008

WJG

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“…While it has never been systematically analyzed, the approach to presumed functional disorders of the biliary tree seems to differ even more strikingly on a global level. Published case series of pediatric patients undergoing cholecystectomies did not include biliary dyskinesia in European studies,19-22 while it accounts for up to more than 50% of the operations in the United States 23-28. Focusing on adult patients, a meta-analysis of surgical case series describing the outcomes after cholecystectomy for biliary dyskinesia similarly only identified studies conducted in the United States 29.…”

Section: Discussionmentioning

confidence: 99%

Regional Differences in Hospitalizations and Cholecystectomies for Biliary Dyskinesia

Bielefeldt

2013

J Neurogastroenterol Motil

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Background/AimsPublished studies suggest that socioeconomic factors contribute to increasing cholecystectomy rates for biliary dyskinesia (BD). The aim of this study was to identify factors driving admissions and operations for BD by examining regional variability in hospitalizations and cholecystectomies for this disorder.MethodsAnnual hospitalizations and cholecystectomy rates for biliary diseases were assessed using the State Inpatient Databases of the Agency for Healthcare Research and Quality based on diagnosis codes for biliary dyskinesia, cholecystolithiasis and cholecystitis.ResultsAnnual admissions for BD varied nearly sevenfold among different states within the United States. Hospitalizations for gallstone disease and its complication showed less variability, differing 2-fold between states. Nearly 70% of admissions for BD and about 85% of admissions for gallstone disease resulted in cholecystectomies. Higher admission rates for BD were best predicted by high overall hospitalization rates, admission rate for gallstone disease and the physician workforce within a state. Cholecystectomy rates for BD were higher in states with low population density and high rates of cholecystectomy for gallstone disease.ConclusionsThese data suggest that established medical practice patterns significantly contribute to the variability in admissions and operations for biliary dyskinesia. The findings also indicate that lower thresholds for operative interventions are an important determinant in the approach to this disorder. Considering the benign course of functional illnesses, the bar for surgical interventions should be raised rather than lowered; in addition active conservative treatment options should be developed for these patients.

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“…Laparoscopy is nowadays considered the standard approach for cholecystectomy [4,5,8], nevertheless controversy still exists on how to investigate the biliary tree in order to prevent injuries to the bile ducts and detect possible associated common bile duct (CBD) stones. The latter occur in some 7 to 18 % of children undergoing cholecystectomy [5,14] and controversy persists both with regard to the imaging necessary to screen for their presence as well as respecting the modality and timing for their treatment [4,6,14].…”

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confidence: 99%