Cholecystectomy versus cholecystolithotomy for cholelithiasis in childhood: Long-term outcome

Background/Purpose: The presence of cholelithiasis is being reported with i ncreased frequency in childhood. Little is known about the natural history of the disease, and only a few studies have been published regarding long-t erm results of treated patients. Controversy still exists regarding optimal treatment. Both cholecystectomy and cholecystolithotomy with gallbladder p reservation have been recommended as the preferred operative intervention. The purpose of this study was to compare the long-term outcome of cholecyst ectomy versus cholecystolithotomy for symptomatic gallbladder disease in ch ildren. Methods: The charts of all patients with symptomatic cholelithiasis treated in the Dublin Paediatric Hospitals during a 25-year period from 1974 till 1999 were reviewed. Data obtained included age, sex, age at presentation of symptoms, methods of diagnosis, indications for operative treatment, time interval between presentation of symptoms and surgery, surgical technique, performance of a preoperative or intraoperative cholangiogram, stone bioche mistry, gallbladder histology, radiologic follow-up, the presence of recurr ent or residual stones and symptoms, and the need for reoperation. Patient data were grouped according to method of surgery. All parameters were compa red and evaluated. Follow-up was by way of telephone contact with all patie nts and completion of a questionnaire. Results: There were 18 patients over a 25-year period. Eight patients under went cholecystectomy, and 10 patients had a cholecystolithotomy. Median fol low-up was 2 years in the cholecystectomy group and 5 years in the cholecys tolithotomy group. All patients in the cholecystectomy group are asymptomat ic and have no recurrent or residual stones on follow-up ultrasound scan. T hirty percent of the patients in the cholecystolithotomy group have recurre nt right upper quadrant pain, and 30% show recurrent stones 9.5 months (ran ge, 7 to 12 months) postoperatively. One patient underwent cholecystectomy 8.5 months postcholecystolithotomy. Conclusions: The symptomatic high stone recurrence rate postcholecystolitho tomy seen in our series suggest that cholecystectomy is the preferred treat ment in patients with symptomatic gallbladder disease. Copyright (C) 2001 b y W.B. Saunders Company.