Carney et al identified factors associated with a positive outcome for a child undergoing cholecystectomy for biliary dyskinesia. This can help select patients who are appropriate candidates for surgery. The authors are from Riley Hospital for Children in Indianapolis.


Patient selection: pediatric patient with biliary dyskinesia


Positive outcome to surgery - one or both of the following:

(1) complete resolution of symptoms

(2) complete satisfaction with medical care (based on a 10 point Likert scale)


Factors predicting benefit from cholecystectomy:

(1) presence of abdominal pain

(2) presence of nausea

(3) gallbladder emptying < 15% after administration of cholecystokinin (using 99m technetium choletec hepatobiliary nuclear scan)


percent emptying =

= ((reading before cholecystokinin) - (reading after cholecystokinin)) / (reading before cholecystokinin) * 100%


The presence of all 3 factors indicates a child with a high probability of benefiting from cholecystectomy. The odds ratios for benefit in univariate analysis (Table 1) were 8 for percent emptying, 5 for nausea and 1.7 for pain.


The absence of all 3 factors suggests a low probability of benefit from surgery.


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