Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients
Topic overview
Multi-institutional study comparing laparoscopic common bile duct exploration (LCBDE) outcomes in 333 pediatric and 391 adult patients with choledocholithiasis found higher success rates in children (82.1% vs 71.4%) with no increased surgical complications. Results support surgery-first approach with LCBDE as equally effective in pediatric patients despite historical hesitation.
Key takeaways
- LCBDE success rate was higher in pediatric patients (82.1%) compared to adults (71.4%), with no increase in surgical complications.
- Surgery-first approach with LCBDE is underutilized in children (41.7% attempted) compared to adults (82.8%) despite superior outcomes.
- Pediatric patients undergoing ERCP-first had significantly higher endoscopic complication rates (9.1% vs 3.6% in adults).
- Limited ERCP access in children combined with high LCBDE success rates supports adopting surgery-first approach for pediatric choledocholithiasis.
- Technical concerns about LCBDE in children appear unfounded—pediatric surgeons can anticipate equal or better stone clearance than in adults.
Comments