Shifting Paradigms in Pediatric Cholelithiasis: A 13-Year Retrospective Study of the Clinicodemographic Profile, Risk Factors, and Outcomes

Abstract

Background: Pediatric cholelithiasis is becoming a more common disease all over the world, and its epidemiology is changing, with a decrease in the incidence of hemolytic causes and a rise in idiopathic and metabolic risk factors. However, long-term data is still limited in the Indian subcontinent. The aim of the present study was to assess the clinicodemographic profile, risk factors, presentation, management, and outcome of cholelithiasis in the pediatric age group in a tertiary care teaching hospital in North India for 13 years. Materials and methods: This was a retrospective observational study of 380 children <15 years who were diagnosed with ultrasonographically confirmed cholelithiasis and treated from January 2013 to December 2025. Hospital records were used to collect demographic data, clinical features, risk factors, ultrasonographic data, operative data, histopathological data, postoperative recovery, and complications. Descriptive statistics included mean ± standard deviation (SD) for continuous variables and frequencies and percentages for categorical variables. Multivariable binary logistic regression was used to identify independent predictors of postoperative complications; results are presented as adjusted odds ratio (AOR) and 95% confidence interval (CI). Results: The age group 11-14 years was the largest (212, 55.8%), and males had the highest prevalence (248, 65.3%). Of the patients, family history (70, 18.4%) and prior antibiotic use (56, 14.7%) were the most frequently recognized risk factors, with almost half (182, 47.9%) having no known association. The most common type of stones was mixed gallstones (246, 64.7%). The most frequent presenting symptom was vague upper abdominal pain (228, 60.0%), and the most common finding on ultrasonography was multiple gallstones (220, 57.9%). The success rate for cholecystectomy was 368 (96.8%), and the number of patients that had to be converted was 8 (2.1%), which was low, and postoperative recovery was excellent. Overall, 308 (81.0%) of patients had no postoperative complications. Multivariable analysis revealed that overweight/obesity, hemolytic disorders, multiple gallstones, intraoperative adhesions, mucocele/empyema, and operative duration >30 minutes were found to be independent factors associated with postoperative complications (AOR > 2, p < 0.05). Temporal trend analysis demonstrated progressive increases in idiopathic and obesity-associated cholelithiasis, accompanied by a decline in hemolytic disorder-associated disease and increasing utilization of laparoscopic cholecystectomy throughout the study period. Conclusions: This 13-year study indicates that there is a definite epidemiological shift in the etiology of pediatric cholelithiasis, with hemolytic disease and idiopathic disease giving way to obesity-associated gallstones. Laparoscopic cholecystectomy was found to have excellent perioperative results, low morbidity, and quick recovery after surgery, suggesting it as the preferred surgical approach for symptomatic gallstones in children. These findings highlight the increasing role metabolic and lifestyle-related factors play in childhood gallstone disease and the importance of recognizing at-risk children early and of conducting multi-center prospective studies to further define the changing epidemiology of gallstones in children and improve management strategies.