Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients | Multicenter Retrospective review | 2018 - 2024 | 724 patients | 333 pediatric | 391 adults | Surgery first: 201 pediatric vs 169 adults | Laparoscopic common bile duct exploration (LCBDE): 84 pediatric vs 140 adults (p = 0.002) | LCBDE success: pediatric >> adults (82.1% vs 71.4%, p = 0.004) | ERCP first: pediatric patients had higher endoscopic complications (9.1% vs 3.6%, p = 0.03) | Complications rates were similar. | Conclusion: LCBDE is highly successful in children with no increased complications, supporting its effectiveness for managing choledocholithiasis, similar to adults. | https://pubmed.ncbi.nlm.nih.gov/39289121/ | Dantes G et. al. | Children's Healthcare of Atlanta, Atlanta, USA | Journal of Pediatric Surgery | @EmGooteeMD | @StayCurrentMD
Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients
Infographic · Jan 2025 · 1 min read
In brief
In brief
Multi-center study comparing surgery-first approach for choledocholithiasis in 724 pediatric and adult patients. Laparoscopic common bile duct exploration showed higher success rates in children than adults with similar complication rates, supporting upfront surgical management in pediatric populations.
- LCBDE achieved 82% stone clearance in pediatric patients vs 71% in adults, demonstrating superior efficacy in children.
- Surgery-first approach was used in 60% of pediatric cases vs 43% of adults, reflecting growing acceptance of LCBDE in children.
- Pediatric patients undergoing ERCP-first had higher endoscopic complications (9.1% vs 3.6%) compared to adults.
- LCBDE in children carries no increased surgical complications compared to adults, supporting its safety profile.
- Limited pediatric ERCP access combined with high LCBDE success rates supports surgery-first approach for pediatric choledocholithiasis.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with illustrated diverse patient figures representing pediatric and adult cohorts. Key statistics are highlighted in pink and orange text, with a stylized gallbladder illustration in the lower right showing stones. The layout flows from top to bottom, presenting study design, patient distribution, surgical approaches, and outcomes with statistical comparisons.
Goeto Dantes, Jessica L. Rauh, Savannah Smith, Eunice Aworanti, Marshall W. Wallace, Irving J. Zamora, Derek Krinock, Sabina Siddiqui, Amanda Witte, Katherine Flynn-O-Brien, Utsav M. Patwardhan, Romeo C. Ignacio, Eric Knauer, Lucas Neff, Hanna Alemayehu
Background: In adults, upfront intraoperative cholangiogram with laparoscopic common bile duct exploration (LCBDE) is well accepted for management of choledocholithiasis. Despite recent evidence supporting LCBDE utility in children, there has been hesitation to adopt this surgery first (SF) approach over ERCP first (EF) due to perceived technical challenges. We compared rates of successful stone clearance during LCBDE between adult and pediatric patients to evaluate if pediatric surgeons could anticipate similar rates of successful clearance.
Methods: A multicenter, retrospective review of pediatric (<18 years) and adult patients with choledocholithiasis managed from 2018 to 2024 was performed. Demographic and clinical data were obtained. Rate of successful duct clearance with LCBDE was compared. Surgical and endoscopic complications (infections, bleeding, pancreatitis, bile leak) were also compared.
Results: 724 patients, 333 (45.9%) pediatric and 391 (54.0%) adults, were included. The median age of pediatric vs adult patients was 15.2 years [13.1, 16.6] vs 55.5 years [34.1, 70.5], respectively. Of these, 201 (60.4%) pediatric vs 169 (43.2%) adult patients underwent SF, p < 0.001. LCBDE was attempted in 84 (41.7%) pediatric vs 140 (82.8%) adults, p = 0.002. LCBDE success was higher in pediatric vs adult patients (82.1% vs 71.4%, p = 0.004). Complications rates were similar however, pediatric patients who underwent EF had higher endoscopic complications (9.1% vs 3.6%, p = 0.03).
Conclusion: LCBDE is highly successful in children vs adults with no increased surgical complications. This data, coupled with the limited ERCP access for children, supports that LCBDE is an equally effective tool for managing choledocholithiasis in children as is accepted in adults.