Choledocholithiasis
Everything in the library about choledocholithiasis — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
1 item
Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024
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Welcome to the 12th Annual Update Course in Pediatric Surgery recap series, hosted by Dr. Em Gootee from Cincinnati Children’s Hospital. In this Green Circle (established practice) session, Drs. David Vitale, Luke Neff, and Jeff Ponsky expl
video7:31 · Jul 2025
Evidence & Research
2 items
Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis
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New article you should know 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
video1:04 · May 2024
Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients
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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, Ha
video0:59 · Mar 2025
In-Depth Reviews
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Choledocholithiasis with Drs. David Vitale & Lucas Neff
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In this episode, we're reviewing the management of choledocholithiasis with with Drs. David Vitale from Cincinnati Children's Hospital & Lucas Neff from Wake Forest Baptist.
Host: Dr. Cecilia Gigena
podcast15:27 · Jul 2024
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Choledocholithiasis with Drs. David Vitale & Lucas Neff
Choledocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity
epidemiologicalDavid Vitale1:03 ↗
Risk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts
clinicalDavid Vitale0:55 ↗
According to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP
guidelineDavid Vitale1:52 ↗
Patients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound
guidelineCecilia Gigena2:11 ↗
In pediatric patients, direct bilirubin or conjugated bilirubin more than 2 was the most predictive factor for common bile duct stones
clinicalDavid Vitale2:40 ↗
Common bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance
clinicalCecilia Gigena2:50 ↗
The pediatric duct score (published in Journal of American College of Surgeons with 10 centers) found that ducts greater than 6 millimeters, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 were the most predictive risk factors
clinicalDavid Vitale3:03 ↗
Pediatric literature with small sample size shows that doing same anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay
clinicalDavid Vitale3:41 ↗
Retrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is probably institution and provider dependent based on expertise
opinionDavid Vitale4:03 ↗
Randomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration
clinicalCecilia Gigena4:18 ↗
Stones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making the procedure more difficult
clinicalDavid Vitale4:39 ↗
Local expertise and availability is probably the most important factor in deciding between ERCP and laparoscopic common bile duct exploration
opinionDavid Vitale5:00 ↗
Most free-standing children's hospitals do not have ERCP capabilities
epidemiologicalCecilia Gigena9:12 ↗
The mantra for laparoscopic common bile duct exploration is all stones go forward, using balloons to dilate the sphincter and flush stones antegrade into the duodenum
clinicalLuke Neff6:42 ↗
If you're having to open up the common bile duct to extract the stone and you had ERCP capability, that's probably not the right thing to do in most cases
opinionLuke Neff7:30 ↗
A 12 gauge angiocath is used for laparoscopic common bile duct exploration, with a new incision made to achieve a flat angle of entry into the cystic ductotomy
clinicalLuke Neff9:37 ↗
A 6 French ureteral stent cut down shorter for better flow is used with a glide wire, employing a cylinder technique to navigate the valves
clinicalLuke Neff9:57 ↗
An angioplasty balloon of 6 or 8 millimeters (but definitely not more than that) is used to dilate the sphincter
clinicalLuke Neff10:37 ↗
The balloon is inflated in the duct and pulled back to provide tactile feedback to locate the sphincter, then partially deflated to straddle the ampulla, then inflated to full profile under fluoroscopy and held for about 5 minutes
clinicalLuke Neff11:02 ↗
Never use a balloon larger than the dilated common bile duct because literature shows a higher rate of pancreatitis with ampullary dilation without sphincterotomy
clinicalDavid Vitale11:23 ↗
If the pancreatic duct is seen on fluoroscopy during the procedure, stop because that has a higher risk for pancreatitis
clinicalCecilia Gigena12:24 ↗
The prevalence of stone disease is increasing
epidemiologicalLuke Neff12:34 ↗
The learning curve for laparoscopic common bile duct exploration is around 5 to 10 cases, though this is person-specific
clinicalLuke Neff13:40 ↗
The position of the 12-gauge angiocath is really important, and the ability to manipulate the catheter and wire in the duct depends on the initial setup and how flat the angle of entry is into the cystic duct
clinicalLuke Neff13:24 ↗
Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients
Dantes et al. performed a multi-center retrospective review of pediatric and adult patients treated for choledocholithiasis between 2018 and 2024
epidemiologicalAlex Halpern0:11 ↗
724 patients were included in the study
epidemiologicalAlex Halpern0:22 ↗
Surgery first approach with upfront laparoscopic cholecystectomy with intraoperative cholangiogram was performed in 201 pediatric patients and 169 adult patients
clinicalAlex Halpern0:25 ↗
Laparoscopic common bile duct exploration was attempted in 84 children and 140 adults in the surgery first group
clinicalAlex Halpern0:35 ↗
Common bile duct exploration success was higher in pediatric than adult patients
clinicalAlex Halpern0:43 ↗
Complication rates were similar between pediatric and adult patients in the surgery first approach
clinicalAlex Halpern0:43 ↗
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