Variability in perioperative evaluation and resource utilization in pediatric patients with suspected biliary dyskinesia: A multi-institutional retrospective cohort study

J Pediatr Surg. 2019 Jun;54(6):1118-1122. doi: 10.1016/j.jpedsurg.2019.02.049. Epub 2019 Mar 2.


Introduction: Biliary dyskinesia (BD) is a common indication for pediatric cholecystectomy. While diagnosis is primarily based on diminished gallbladder ejection fraction (GB-EF), work-up and management in pediatrics is controversial.

Methods: We conducted a multi-institutional retrospective review of children undergoing cholecystectomy for BD to compare perioperative work-up and outcomes.

Results: Six hundred seventy-eight patients across 16 institutions were included. There was no significant difference in gender, age, or BMI between institutions. Most patients were white (86.3%), non-Hispanic (79.9%), and had private insurance (55.2%). Gallbladder ejection fraction (EF) was reported in 84.5% of patients, and 44.8% had an EF <15%. 30.7% of patients were initially seen by pediatric surgeons, 31.3% by pediatric gastroenterologists, and 23.4% by the emergency department with significant variability between institutions (p < 0.001). Symptoms persisted in 35.3% of patients post-operatively with a median follow-up of 21 days (IQR 13, 34). On multivariate analysis, only non-white race and the presence of psychiatric comorbidities were associated with increased risk of post-operative symptoms.

Conclusion: There is significant variability in evaluation and follow-up both before and after cholecystectomy for BD. Prospective research with standardized data collection and follow-up is needed to develop and validate optimal care pathways for pediatric patients with suspected BD.

Study type: Case Series, Retrospective Review.

Level of evidence: Level IV.

Keywords: Biliary dyskinesia; Cholecystectomy; Functional gallbladder disorder; Gastroenterology; Pediatric surgery.

MeSH terms

  • Biliary Dyskinesia* / epidemiology
  • Biliary Dyskinesia* / surgery
  • Child
  • Cholecystectomy / statistics & numerical data
  • Gallbladder / surgery
  • Humans
  • Retrospective Studies