Unmasking biliary dyskinesia in children through systematic review and meta- analysis of 3,348 patients over the last two decades.

BACKGROUND

Biliary dyskinesia (BD) is an increasingly common indication for pediatric cholecystectomy, but diagnostic criteria and outcomes remain debated. We conducted a systematic review and meta-analysis to evaluate symptom resolution, complications, and histopathology in children undergoing cholecystectomy for BD.

METHODS

Following PRISMA 2020 guidelines, PubMed, Embase, and CENTRAL were searched for observational studies of patients <18 years undergoing cholecystectomy for BD. Pooled proportions were calculated using random-effects models.

RESULTS

Forty studies, including 3348 children, were analyzed. Symptom resolution was reported in 34 studies (2609 patients), with a pooled rate of 69 %. Histopathology demonstrated chronic cholecystitis in about 65 % of cases. Perioperative complications were reported in 1865 patients, with an overall rate of 30 %; the most frequent were biliary leak (0.7 %) and wound infection (0.1 %). No conversions to open surgery were reported, and readmission occurred in 6 %.

CONCLUSIONS

Cholecystectomy for pediatric biliary dyskinesia appears safe and frequently associated with symptom improvement. Histopathologic evidence of inflammation suggests that many cases represent an organic rather than purely functional disorder. However, wide variability in outcomes and the lack of standardized diagnostic criteria highlight the need for prospective, multicenter studies to improve patient selection and refine management strategies.