Childhood cholecystectomy in New Zealand: a multi-centre national 10 year perspective

Aim: International studies show increasing incidence of cholelithiasis in childhood and an increasing caseload for the pediatric surgeon. We reviewed pediatric cholecystectomy in all four centers in New Zealand, examining changes in incidence and the demographics of the patient population. Method: Coding data were used to retrieve case notes and extract demographic data, diagnosis, comorbidities, length of stay, and complications for patients less than 16 years old undergoing cholecystectomy from January 1st, 2004-December 31st, 2013. Patients with congenital biliary malformations were excluded. Statistical analysis was performed using SPSS. Results: 170 children required cholecystectomy. On average, 15 procedures were performed annually (IQR 8-24). There was a slight upward trend, with a gradient of 0.34 (P = 0.63). Median age was 14 (range 2-15) years, male: female 2: 3. While 72% of children were Caucasian, Maori were significantly overrepresented (20%). Numbers of Pacific Islander increased significantly over time (P = 0.05), in line with population increases. Of 114 patients with complete dataset, 31% were overweight or obese. Complication rates were 8.8% overall, but 27% of complications occurred in Maori children. 40% of those suffering a complication were obese. Three complications were major, requiring return to theater. Mean length of stay was 5 days. Conclusions: New Zealand has not seen the rapid increase in pediatric cholecystectomy experienced elsewhere in the OECD. However, the problem of adolescent biliary disease is prevalent. The average recipient of a cholecystectomy is 14 years old, overweight, and Caucasian; though Maori have a high relative risk of both biliary disease and complicated postoperative course. The reasons for this remain unclear and require further study. (C) 2016 Elsevier Inc. All rights reserved.