Pediatric cholelithiasis: a comprehensive analysis of clinical characteristics and surgical treatment strategies.

Background: Pediatric cholelithiasis is a biliary system calculus resulting from complex pathogenesis, which is a significant public health issue affecting children's health. This study aimed to analyze the clinical characteristics of pediatric cholelithiasis, including demographic characteristics, primary diseases, symptoms, and imaging features, then investigated the treatment strategies and effects of different types of cholelithiasis. Methods: The study retrospectively included and analyzed clinical data of children with cholelithiasis, who were admitted to the Surgery Department of Tianjin Children's Hospital between June 2017 and January 2024. These patients underwent either conservative or surgical management during their hospitalization. The following data were systematically collected: general clinical characteristics, primary comorbidities, imaging features, and perioperative laboratory indicators. Based on the World Health Organization (WHO) Child Growth Standards, the growth condition of patients was categorized into four levels: normal, overweight, obesity, and thinness. The treatment modalities for gallbladder stones and cholangiolithiasis were summarized and analyzed, and patients who received surgical treatment underwent follow-up evaluation. Results: A total of 185 patients were retrospectively reviewed: 57.8% patients had gallbladder stones, 25.4% patients had cholangiolithiasis, and 16.8% of them suffered from both conditions. The number of female patients exceeded that of male patients, but no statistically significant differences were observed between genders. The median age of onset for cholelithiasis was 7.5 (3.7-11.0) years, only 22.4% were classified as overweight or obesity. About 60% of patients had normal body mass index (BMI) values. In patients diagnosed with gallbladder stones, laparoscopic cholecystectomy (LC) and laparoscopic choledochoscopic cholecystolithotomy were predominantly employed in clinical practice. Postoperative follow-up of the cholecystectomy group was 43.8±33.0 months, with no recurrence observed. The recurrence rate of Gallbladder-preserving lithotomy group was 14.3%, following a mean follow-up of 23.1±12.3 months. Among patients with bile duct stones, endoscopic therapy accounted for 20.5% of interventions. The average postoperative hospital stay was 5.6±2.2 days. Two cases of recurrence were observed at 48 and 3 months post-endoscopic retrograde cholangiopancreatography (ERCP), respectively. However, follow-up periods should be extended to ensure long-term outcomes. Conclusions: Our study indicated that attention should be paid to pediatric patients with normal body weight, and individualized therapeutic approaches should be promoted in the management of pediatric cholelithiasis. Conservative observation should be the first-line treatment, cholecystectomy is effective for severe conditions such as severe purulent exudation, atrophy, necrosis, and perforation of the gallbladder wall. Gallbladder-preserving lithotomy could be considered when gallbladder morphology and function are normal. Endoscopic therapy effectively resolves biliary obstruction and secondary bile duct dilatation, improving liver function simultaneously.