Clinical Characteristics of Pediatric Patients with Gallbladder Disease Surgically Treated at the Clinic for Pediatric Surgery, Clinical Center of the University of Sarajevo, over a 15-year Period

Abstract

Introduction: Acquired gallbladder diseases in the pediatric population, although rare, are becoming increasingly recognized in clinical practice. The growing number of pediatric cholecystectomies may be attributed to improved diagnostic modalities as well as to shifts in etiological patterns, including the rising prevalence of obesity and metabolic disorders among children and adolescents.
Aim: The aim of this study was to analyze the clinical and laboratory presentation, diagnostic evaluation, and treatment of pediatric patients who underwent cholecystectomy at the Clinic for Pediatric Surgery, University of Sarajevo, between 2010 and 2024.
Materials and Methods: This retrospective descriptive study included 41 patients who underwent cholecystectomy. Medical records were reviewed to collect data on clinical presentation and disease course. Based on the median age within the sample, patients were stratified into two groups: children under 14 years and those aged 14 years or older.
Results: 41 patients were included in the study, comprising 25 (61%) girls and 16 (39%) boys. Between 2010 and 2024, the number of cholecystectomized patients increased by 11.2% annually (p = 0.0057). The median patient age was 14 years. The mean BMI was 23.2 ± 4.66 kg/m²; 51.22% of patients were overweight, and 4.88% were obese. The most frequent diagnosis was chronic calculous cholecystitis, confirmed in 36 patients (87.8%). Spherocytosis was documented in 7 patients (17.7%). Multiple gallstones were present in 29 patients (74.36%), and the majority of sonographically detected gallstones (31 patients, 79.49%) were smaller than 5 mm. Smaller stones tended to occur more frequently (p = –0.53, p < 0.001). Laparoscopic cholecystectomy was performed in 37 patients (90.24%). The average length of hospitalization decreased by approximately 11.9% annually (p < 0.01). Gallstone color was reported in the histopathological findings of 16 patients (41.03%), of which 9 were cholesterol (56.25%) and 7 pigment stones (43.75%). With each additional year of age, the risk of undergoing cholecystectomy increased by 21.5% (p < 0.01). Pigment stones were significantly more frequent in children under 14, while cholesterol stones predominated in those aged 14 years or older (p = 0.0406).
Conclusion: The incidence of gallbladder disease is continuously increasing in the pediatric population. Obesity and older pediatric age are significant risk factors for cholelithiasis and cholecystitis. Laparoscopic cholecystectomy remains the standard treatment approach.