Cholelithiasis and cholecystitis in children and adolescents: Does this increasing diagnosis require a common guideline for pediatricians and pediatric surgeons?

Abstract

Background: 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.

Methods: We 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.

Results: Management 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.

Conclusions: The 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.

Keywords: Cholecystitis; Pediatric gallstones; Symptomatic cholecystolithiasis.

Fig. 1

Questionnaire of the online survey, including given answers. Question 1/2 contained demographical information about the participants. Values have been rounded for clarity. Annotations: × 1: “10% 6–8 y”; × 2: “2% visceral surgery, 8% combined”; × 3: “10% mainly laparoscopic approach”. The full online survey is presented as part of the Additional file 1 of this manuscript. CL cholelithiasis, ERCP endoscopic retrograde cholangiopancreatography

Fig. 2

a Answers to question Q9: Results of the online survey due to concomitant disorders of cholelithiasis (answered by 47 respondents (92%)). b Answers to question Q19: Composition of conservative treatment of cholecystitis with cholelithiasis according to the results of the online survey (answered by 46 respondents (90%))

Fig. 3

Diagnostics and Therapy Flow Chart. A draft of a flow chart based on close teamwork between pediatricians and pediatric surgeons for optimal diagnostic and therapeutic algorithm until evidence-based pediatric guidelines are available in pediatric cholelithiasis. A primarily pediatric medical admission is assumed