Surgical Management of Gallstone Pancreatitis in Children

Introduction: Because of the low incidence of gallstone pancreatitis in children, we sought to examine effects of varied practice patterns on outcomes. Subjects and Methods: A retrospective review was performed on all patients undergoing cholecystectomy for a diagnosis of gallstone pancreatitis from January 2000 to June 2011. Demographics, diagnostic strategies, operative approaches, length of stay, and morbidity were compared between Group 1, who had cholecystectomy performed during the admission of diagnosis, and Group 2, who underwent cholecystectomy subsequently. Results: Cholecystectomy was performed for gallstone pancreatitis in 41 patients, of whom 29 (70.7%) patients were female. Ultrasound was performed in all cases, revealing cholelithiasis in 37 (90.2%). There were 22 patients in Group 1 and 19 in Group 2. Mean age and body mass index did not vary between groups. Endoscopic retrograde cholangiopancreatography was performed in 14 patients (8 in Group 1 and 6 in Group 2), of these procedures 11 were prior to cholecystectomy, 2 were after cholecystectomy, and 1 was both. Total number of hospital days attributed to the diagnosis of gallstone pancreatitis was 8.9 +/- 6.5 in Group 1 compared with 14.0 +/- 14.4 in Group 2 (P = .15). There were 7 patients (36.8%) in Group 2 who required readmission for recurrent pancreatitis prior to their operation. Conclusions: This represents the largest reported series of cholecystectomy for gallstone pancreatitis in children. Our results support the use of laparoscopic cholecystectomy during the initial hospitalization as is recommended in the adult literature, and this approach may decrease the total hospital stay.