Medical management of biliary stone disease in pediatric patients

Cholelithiasis and its associated conditions are increasingly encountered by pediatric surgeons. Multiple factors contribute to the increase in prevalence of cholelithiasis in children as well as the increasing need for intervention due to symptomatic cholelithiasis and the associated complications including gallstone pancreatitis and choledocholithiasis. Surgeons are often called on to manage these conditions operatively. However, many times pediatric surgeons may be consulted early in the clinical course when these biliary stones are found incidentally and are asymptomatic or minimally symptomatic. Additional complicating factors, such as comorbidities or younger age, may render these potential surgical patients suboptimal candidates for surgical management. It is therefore important that pediatric surgeons have a basic understanding of the options for non-operative or medical management of these patients. While this issue of Seminars in Surgery will primarily focus on the surgical management of biliary stone disease given the audience of pediatric surgeons, this section will provide a brief review of non-operative management strategies for pediatric patients presenting with cholelithiasis or one of its complications.