Paediatric cholelithiasis: our experience at a tertiary … Sri Lanka Journal of Child Health, 2021; 50(2): 286-293 286 Paediatric cholelithiasis: our experience at a tertiary care centre *Vinit Kumar Thakur 1 , Zaheer Hasan 1 , Sandip Kumar Rahul 2 , Digamber Chaubey 2 , Ramdhani Yadav 3 , Vijayendra Kumar 4 , Ramjee Prasad 2 , Rakesh Kumar 5 Sri Lanka Journal of Child Health, 2021; 50(2): 286-293 Abstract Background: With increased incidence of symptomatic and asymptomatic gallstones in children, paediatric cholelithiasis has emerged as an important pathology in children. A retrospective study evaluates paediatric cholelithiasis and its management at a tertiary centre. Objectives: To study the spectrum of paediatric cholelithiasis and its management issues. Method: A retrospective study was conducted at a tertiary care on all patients of paediatric cholelithiasis (children less than 14 years) who were managed from April, 2017 to March, 2020. Data regarding demographic profile, clinical history, investigation results, management and postoperative outcomes were collected and analysed. Results: Of the 52 ultrasound-confirmed cases of gallstones, 35 showed biliary and dyspeptic symptoms; while 17 were asymptomatic. Males outnumbered females; no child less than three years came with gallstones. No definite aetiology was found in 32 cases. Cholecystectomy was done in 40 patients (laparoscopic in 37 cases, open in three cases). Stone analysis revealed mixed stones (thirty cases), pigment stones (eight cases) and pure cholesterol stones (two cases). 10/17 cases of asymptomatic gallstones showed complete stone resolution from gallbladder on follow-up sonogram after six months; 5/17 showed no regression of stones (one symptomatic and rest four underwent elective surgery due to parental anxiety); 2/17 cases were lost to follow up. No major complication was seen. _________________________________________ 1 Additional Professor, 2 Assistant Professor, 3 Associate Professor, 4 Professor, 5 Senior Resident, Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India *Correspondence: dr.vinit.igims@gmail.com https://orcid.org/0000-0002-9211-2864 (Received on 17 June 2020: Accepted after revision on 24 July 2020) The authors declare that there are no conflicts of interest Personal funding was used for the project. Open Access Article published under the Creative Commons Attribution CC-BY License Conclusions: Of the 52 ultrasound-confirmed cases of gallstones, 32.7% were asymptomatic and 61.5% had no definite aetiology. Of the asymptomatic cases 58.8% showed complete stone resolution from gallbladder on follow-up sonogram after six months DOI: http://dx.doi.org/10.4038/sljch.v50i2.9576 (Keywords: Asymptomatic, cholelithiasis, cholecystectomy, paediatric, resolution) Introduction Recent trends show increased incidence of gallstones in childhood 1 . A population-based study showed a childhood gallstone prevalence of 1.9%, still less than that in an adult 2 . This can also be attributed to an increase in the use of ultrasonography (USG) in diagnosis. The cause, presentation and natural course of paediatric gall stone disease is known to be different than in adults. In a considerable number of cases, babies remain asymptomatic. Although the underlying pathology remains obscure in most cases just like in adults, haemolytic causes have been reported to have an important role 2,3 . This retrospective study was conducted to evaluate all children with gallstones for their symptoms, clinical features, natural course and outcome so as to emphasize the differences of paediatric gallstone disease from that of adults. Objectives To study the spectrum of paediatric cholelithiasis and its management issues Method All USG-confirmed paediatric cases of cholelithiasis managed at a tertiary care centre from April, 2017 to March, 2019 were studied retrospectively. All children less than 14 years old with gallstones on USG were included in study and divided into two groups. Group 1 comprised symptomatic patients who underwent surgery. Group 2 comprised asymptomatic patients who were followed up with periodic USG every three months and regular clinical monthly follow-up. If any of these patients became symptomatic, they were operated. Surgery was also considered if parents wanted to have it by choice when gallstones persisted on follow-up USG. Ethical issues: Ethical clearance was obtained from the Indira Gandhi Institute of Medical Sciences, Sheikpura, Patna, India (036/IEC/IGIMS/2019).