Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis

Infographic · May 2024 · 1 min read

In brief

Multi-center study of 252 pediatric patients demonstrates that upfront laparoscopic cholecystectomy with intraoperative cholangiogram and transcystic bile duct exploration reduces hospital stay and complications compared to preoperative ERCP. The approach achieved definitive treatment in 86% of cases, avoiding ERCP in most patients.

Upfront LC with IOC ± transcystic LCBDE reduces length of stay (2.39 vs 3.84 days) and complications compared to preoperative ERCP approach
86% of pediatric choledocholithiasis cases achieved definitive intraoperative management with LCBDE, avoiding need for ERCP
OR-first strategy (LC + IOC ± LCBDE) decreases total number of interventions and ERCP procedures in children with suspected bile duct stones
Postoperative ERCP remains necessary for 14% of LCBDE cases that fail intraoperative clearance
Increased training in IOC and transcystic LCBDE techniques needed to expand adoption of OR-first approach in pediatric surgery

Written by the GCMD Library team from the infographic.

The infographic uses a teal and yellow color scheme with a calendar icon on the left indicating a retrospective study from 2018-2022. The center displays a large number '252' followed by study group descriptions. Results are presented in two columns comparing Group OR1st (156 patients) and Group OR2nd (96 patients), with a stylized liver illustration in the background. Complications and length of stay metrics are highlighted with statistical significance markers. A yellow conclusion box appears on the right side.

New infographic by Cecilia Gigena from Journal of Pediatric Surgery

"Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis: A multi-center study"

Authors: Jessica Rauh, Goeto Dantes, Marshall Wallace, Amelia Collings, Gloria D. Sanin, Gabriel E. Cambronero, Maggie E. Bosley, Aravindh S. Ganapathy, James W. Patterson, Romeo Ignacio, Jennifer Leslie Knod, Bethany Slater, Kylie Callier, Michael H. Livingston, Hanna Alemayehu, Katerina Dukleska, Stefan Scholz, Matthew T. Santore, Irving J. Zamora, Lucas P. Neff

Full article: https://gcmd.co/3Jy2LVA

Background

Patients with choledocholithiasis are often treated with endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). Upfront LC, intraoperative cholangiogram (IOC), and possible transcystic laparoscopic common bile duct exploration (LCBDE) could potentially avoid the need for ERCP. We hypothesized that upfront LC + IOC ± LCBDE will decrease length of stay (LOS) and the total number of interventions for children with suspected choledocholithiasis.

Methods

A multicenter, retrospective cohort study was performed on pediatric patients (<18 years) between 2018 and 2022 with suspected choledocholithiasis. Demographic and clinical data were compared for upfront LC + IOC ± LCBDE and possible postoperative ERCP (OR1st) versus preoperative ERCP prior to LC (OR2nd). Complications were defined as postoperative pancreatitis, recurrent choledocholithiasis, bleeding, or abscess.

Results

Across four centers, 252 children with suspected choledocholithiasis were treated with OR1st (n = 156) or OR2nd (n = 96). There were no differences in age, gender, or body mass index. Of the LCBDE patients (72/156), 86% had definitive intraoperative management with the remaining 14% requiring postoperative ERCP. Complications were fewer and LOS was shorter with OR1st (3/156 vs. 15/96; 2.39 vs 3.84 days, p < 0.05).

Conclusion

Upfront LC + IOC ± LCBDE for children with choledocholithiasis is associated with fewer ERCPs, lower LOS, and decreased complications. Postoperative ERCP remains an essential adjunct for patients who fail LCBDE. Further educational efforts are needed to increase the skill level for IOC and LCBDE in pediatric patients with suspected choledocholithiasis.

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