PURPOSE: To compare anthropometric data (body mass index [BMI]) in patients without lithiasis to patients with symptomatic simple cholelithiasis or choledocholithiasis. METHODS: We retrospectively reviewed data from 147 patients undergoing laparoscopic cholecystectomy between 2001-2015. Complete growth data from 98 patients was compared with anthropometric data from the population of the Czech Republic and a control group (BMI of 100 consecutive patients without biliary stones in abdominal ultrasound who were admitted to a surgical department for suspected appendicitis). RESULTS: The BMI of 75 children with simple cholelithiasis and 23 with choledocholithiasis was compared to the standard Czech pediatric population and to the control group. The median age (simple cholelithiasis and choledocholithiasis) was 16 years, and 35 patients (24%) had a family history of gallstones. Types of lithiasis included multiple (n = 120), solitary (n = 11), and sludge (n = 10). Five cases had polyps and one had gallbladder dysplasia. Patients with simple cholelithiasis had significantly higher BMI compared to the control group without cholelithiasis (p<0.0001) and the standard Czech population (p = 0.03). Patients with choledocholithiasis had a mean BMI significantly higher than that of the general population (p = 0.001) and the control group (p = 0.0001). Patients with choledocholithiasis had significantly higher BMI than those with simple cholelithiasis (p = 0.03). CONCLUSION: Patients with cholelithiasis had significantly higher BMI than the general population, and patients with choledocholithiasis had significantly higher BMI than patients with simple lithiasis. Elevated BMI is a risk factor for developing choledocholithiasis. ERCP and early laparoscopic cholecystectomy in patients with choledocholithiasis offer equivalent outcomes in patients with simple cholelithiasis.

2nd Department of Internal Medicine Gastroenterology Charles University Prague Faculty of Medicine in Hradec Kralove University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Anaesthesiology and Intensive Care Medicine Charles University Prague 2nd Faculty of Medicine University Hospital in Motol Prague Prague Czech Republic

Department of Internal Medicine Charles University Prague 2nd Faculty of Medicine University Hospital Motol Prague Prague Czech Republic

Department of Pediatric Surgery Charles University Prague 2nd Faculty of Medicine University Hospital Motol Prague Prague Czech Republic

Department of Pediatrics Charles University Prague 2nd Faculty of Medicine University Hospital Motol Prague Prague Czech Republic

Department of Radiology Charles University Prague 2nd Faculty of Medicine University Hospital Motol Prague Prague Czech Republic

See more in PubMed

Bălănescu RN, Bălănescu L, Drăgan G, Moga A., & Caragaåã R. Biliary lithiasis with choledocolithiasis in children. Chirurgia (Bucur). 2015;110(6):559–61 PubMed

Pastucha D., Talafa V., Malincikova J., Cihalik C., Hyjanek J., Horakova D. et al. Obesity, hypertension and insulin resistance in childhood–a pilot study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010; 154(1):77–82. PubMed

Jeanty C., Derderian S. C., Courtier J., & Hirose S. Clinical management of infantile cholelithiasis, J Pediatr Surg. 2015;50(8):1289–92. doi: 10.1016/j.jpedsurg.2014.10.051 PubMed DOI

Marcia L. Buck,: Use of Ursodiol in Infants and Children, Pediatric Pharmacotherapy, volume 15, number 2, February 2009

Lammert F., Acalovschi M., Ercolani G., van Erpecum K. J., Gurusamy K., van Laarhoven C. J. et al.: EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. Journal of Hepatology. 2016;65:146–181 doi: 10.1016/j.jhep.2016.03.005 PubMed DOI

Kobzova J., Vignerova J., Blaha P., Krejcovsky L., & Riedlová J. The 6th nationwide anthropological survey of children and adolescents in the Czech Republic in 2001. Cent Eur J Public Health. 2004;12(3):126–30 PubMed

Kaechele V., Wabitsch M., Thiere D., Kessler A. L., Haenle M. M., Mayer H, et al.: Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development. J Pediatr Gastroenterol Nutr. 2006. January; 42(1):66–70. PubMed

Koebnick C, Smith N, Black MH, Porter AH., Richie BA, Hudson S, et al.: Pediatric obesity and gallstone disease: results from a cross-sectional study of over 510,000 youth. J Pediatr Gastroenterol Nutr., 2012:5(3): 328. PubMed PMC

Fradin K, Racine AD, Belamarich PF: Obesity and symptomatic cholelithiasis in childhood: epidemiologic and case-control evidence for a strong relation. J Pediatr Gastroenterol Nutr 2014:58(1): 102–106. doi: 10.1097/MPG.0b013e3182a939cf PubMed DOI

Noblett K. L., Jensen J. K., & Ostergard D. R. The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(6):323–6. PubMed

Ejike JC1, Kadry J, Bahjri K, Mathur M. Semi-recumbent position and body mass percentiles: effects on intra-abdominal pressure measurements in critically ill children.Intensive Care Med. 2010. February;36(2):329–35. doi: 10.1007/s00134-009-1708-9. Epub 2009 Nov 7. PubMed DOI

Sanchez N. C., Tenofsky P. L., Dort J. M., & Shen L. Y. What is normal intra-abdominal pressure? Am Surg. 2001. March;67(3):243–8. PubMed

Lambert D. M., Marceau S., & Forse R. A. Intra-abdominal pressure in the morbidly obese. Obes Surg. 2005. October;15(9):1225–32. doi: 10.1381/096089205774512546 PubMed DOI

Sahuquillo J., Arikan F., Poca M. A., Noguer M., & Martinez-Ricarte F. Intra-abdominal pressure: the neglected variable in selecting the ventriculoperitoneal shunt for treating hydrocephalus. Neurosurgery. 2008. January;62(1):143–9; discussion 149–50. doi: 10.1227/01.NEU.0000311071.33615.E1 PubMed DOI

Pozo MJ1, Camello PJ, Mawe GM.Chemical mediators of gallbladder dysmotility. Curr Med Chem. 2004. July;11(13):1801–12. PubMed

Schjoldager BT. Role of CCK in gallbladder function. Ann N Y Acad Sci. 1994. March 23;713:207–18. PubMed

Chiloiro M., Caroli M., Guerra V., Piepoli A. L., & Riezzo G. Gastric emptying in normal weight and obese children—an ultrasound study. Int J Obes Relat Metab Disord. 1999. December;23(12):1303–6. PubMed

Jaruvongvanich V, Sanguankeo A, Upala S: Significant association between gallstone disease and nonalcoholic fatty liver disease: a systematic review and meta-analysis. Digestive diseases and sciences 618 (2016): 2389–2396. doi: 10.1007/s10620-016-4125-2 PubMed DOI

Loria P., Lonardo A., Lombardini S., Carulli L., Verrone A., Ganazzi D, et al.: Gallstone disease in non alcoholic fatty liver: Prevalence and associated factors. Journal of gastroenterology and hepatology 208 (2005): 1176–1184. doi: 10.1111/j.1440-1746.2005.03924.x PubMed DOI

Huang J. S., Barlow S. E., Quiros-Tejeira R. E., Scheimann A., Skelton J., Suskind D, et al. Childhood obesity for pediatric gastroenterologists. J Pediatr Gastroenterol Nutr 2013; 56:99 doi: 10.1097/MPG.0b013e31826d3c62 PubMed DOI PMC

Baldridge A. D., Perez-Atayde A. R., Graeme-Cook F., Higgins L., & Lavine J. E.: Idiopathic steatohepatitis in childhood: a multicenter retrospective study. The Journal of pediatrics1275 (1995): 700–704. PubMed

Kiuru E., Kokki H., Juvonen P., Lintula H., Paajanen H., Gissler M, et al.: The impact of age and sex adjusted body mass index (ISO-BMI) in obese versus non-obese children and adolescents with cholecystectomy. In Vivo. 2014. Jul-Aug;28(4):615–9. PubMed

Farkas D. T., Moradi D., Moaddel D., Nagpal K., & Cosgrove J. M.: The impact of body mass index on outcomes after laparoscopic cholecystectomy. Surg Endosc. 2012. April;26(4):964–9. doi: 10.1007/s00464-011-1978-5. Epub 2011 Oct 20. PubMed DOI