Abstract
BackgroundIn contrast to adults, for whom guidelines on the cholelithiasis treatment exist, there is no consistent treatment of pediatric patients with cholelithiasis throughout national and international departments, most probably due to the lack of evidence-based studies.MethodsWe evaluated the German management of pediatric cholelithiasis in a dual approach. Firstly, a retrospective, inter-divisional study was established, comparing diagnostics and therapy of patients of the pediatric surgery department with the management of patients aged < 25 years of the visceral surgery department in our institution over the past ten years. Secondarily, a nation-wide online survey was implemented through the German Society of Pediatric Surgery.ResultsManagement of pediatric patients with cholelithiasis was primarily performed by pediatricians in the retrospective analysis (p < 0.001). Pediatric complicated cholelithiasis was not managed acutely in the majority of cases with a median time between diagnosis and surgery of 22 days (range 4 days–8 months vs. 3 days in visceral surgery subgroup (range 0 days–10 months), p = 0.003). However, the outcome remained comparable. The hospital’s own results triggered a nation-wide survey with a response rate of 38%. Primary pediatric medical management of patients was confirmed by 36 respondents (71%). In case of acute cholecystitis, 22% of participants perform a cholecystectomy within 24 h after diagnosis. Open questions revealed that complicated cholelithiasis is managed individually.ConclusionsThe management of pediatric cholelithiasis differs between various hospitals and between pediatricians and pediatric surgeons. Evidence-based large-scale population studies as well as a common guideline may represent very important tools for treating this increasing diagnosis.
Highlights
In contrast to adults, for whom guidelines on the cholelithiasis treatment exist, there is no consistent treatment of pediatric patients with cholelithiasis throughout national and international departments, most probably due to the lack of evidence-based studies
Results of the retrospective analysis, comparing management of pediatric and visceral surgery A total of 87 patients with cholelithiasis was treated at our university center
Diagnosis of cholelithiasis is rare in younger children and increases with progressing age
Summary
For whom guidelines on the cholelithiasis treatment exist, there is no consistent treatment of pediatric patients with cholelithiasis throughout national and international departments, most probably due to the lack of evidence-based studies. Separate treatment guidelines in the pediatric sector on the basis of evidence-based large-scale population studies are either lacking, outdated or represent expert opinions of distinct hospitals (e.g., Sweden [2], Brazil [9], India [10], USA [11], Egypt [12], Iran [13]). This is significant with regard to the timing of surgery. Even though the results are being controversially discussed [14], they recommend an early cholecystectomy within the first 48 h of symptoms of acute cholecystitis and an elective cholecystectomy in symptomatic cases without signs of inflammation
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