Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis: A Multi-Center Study
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 a...
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| Veröffentlicht in: | Journal of pediatric surgery 2024-03, Vol.59 (3), p.389-392 |
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| creator | Rauh, Jessica Dantes, Goeto Wallace, Marshall Collings, Amelia Sanin, Gloria D. Cambronero, Gabriel E. Bosley, Maggie E. Ganapathy, Aravindh S. Patterson, James W. Ignacio, Romeo Knod, Jennifer Leslie Slater, Bethany Callier, Kylie Livingston, Michael H. Alemayehu, Hanna Dukleska, Katerina Scholz, Stefan Santore, Matthew T. Zamora, Irving J. Neff, Lucas P. |
| description | 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.
A multicenter, retrospective cohort study was performed on pediatric patients ( |
| doi_str_mv | 10.1016/j.jpedsurg.2023.10.046 |
| format | Article |
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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.
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).
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.
Level III.
•This is the first multi-center retrospective study comparing operative first verses operative second approach in pediatric patients with choledocholithiasis.•Management of choledocholithiasis with upfront LC + IOC ± LCBDE is associated with decreased LOS and reduced need for a second procedure. Postoperative ERCP remains an essential adjunct for patients who fail duct clearance with LCBDE.•Further educational efforts are needed to increase familiarity and the adoption of IOC and LCBDE in pediatric patients with suspected choledocholithiasis.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2023.10.046</identifier><identifier>PMID: 37957103</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Child ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Choledocholithiasis ; Choledocholithiasis - surgery ; Common Bile Duct - surgery ; Humans ; Length of Stay ; LTCBDE ; Pediatric ; Retrospective Studies</subject><ispartof>Journal of pediatric surgery, 2024-03, Vol.59 (3), p.389-392</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-9ed4ff97c8e49455896279d00c1dae7732aebcd9701bc1e0792b5361d55ca1653</citedby><cites>FETCH-LOGICAL-c368t-9ed4ff97c8e49455896279d00c1dae7732aebcd9701bc1e0792b5361d55ca1653</cites><orcidid>0000-0003-1683-9786 ; 0000-0001-7259-8679 ; 0009-0000-8731-0084 ; 0009-0005-3487-3074 ; 0000-0003-4534-0116 ; 0000-0002-9627-4334 ; 0000-0002-5203-3352 ; 0009-0000-9640-9625 ; 0000-0002-3397-6208 ; 0000-0001-8466-1700 ; 0000-0002-3475-3444 ; 0000-0002-8815-1262 ; 0000-0001-6398-7170</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022346823006577$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37957103$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rauh, Jessica</creatorcontrib><creatorcontrib>Dantes, Goeto</creatorcontrib><creatorcontrib>Wallace, Marshall</creatorcontrib><creatorcontrib>Collings, Amelia</creatorcontrib><creatorcontrib>Sanin, Gloria D.</creatorcontrib><creatorcontrib>Cambronero, Gabriel E.</creatorcontrib><creatorcontrib>Bosley, Maggie E.</creatorcontrib><creatorcontrib>Ganapathy, Aravindh S.</creatorcontrib><creatorcontrib>Patterson, James W.</creatorcontrib><creatorcontrib>Ignacio, Romeo</creatorcontrib><creatorcontrib>Knod, Jennifer Leslie</creatorcontrib><creatorcontrib>Slater, Bethany</creatorcontrib><creatorcontrib>Callier, Kylie</creatorcontrib><creatorcontrib>Livingston, Michael H.</creatorcontrib><creatorcontrib>Alemayehu, Hanna</creatorcontrib><creatorcontrib>Dukleska, Katerina</creatorcontrib><creatorcontrib>Scholz, Stefan</creatorcontrib><creatorcontrib>Santore, Matthew T.</creatorcontrib><creatorcontrib>Zamora, Irving J.</creatorcontrib><creatorcontrib>Neff, Lucas P.</creatorcontrib><title>Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis: A Multi-Center Study</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>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.
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.
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).
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.
Level III.
•This is the first multi-center retrospective study comparing operative first verses operative second approach in pediatric patients with choledocholithiasis.•Management of choledocholithiasis with upfront LC + IOC ± LCBDE is associated with decreased LOS and reduced need for a second procedure. Postoperative ERCP remains an essential adjunct for patients who fail duct clearance with LCBDE.•Further educational efforts are needed to increase familiarity and the adoption of IOC and LCBDE in pediatric patients with suspected choledocholithiasis.</description><subject>Child</subject><subject>Cholangiopancreatography, Endoscopic Retrograde</subject><subject>Cholecystectomy, Laparoscopic</subject><subject>Choledocholithiasis</subject><subject>Choledocholithiasis - surgery</subject><subject>Common Bile Duct - surgery</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>LTCBDE</subject><subject>Pediatric</subject><subject>Retrospective Studies</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1v1DAQhi0EokvhL1Q-csnWH3ESc6KEFpAWUYlytrz2hHqVrIPtACv-PLPaliun0bx6ZkbzEHLB2Zoz3lzu1rsZfF7S97VgQmK4ZnXzhKy4krxSTLZPyYoxISpZN90ZeZHzjjGMGX9OzmSrVcuZXJE_d8nuszvkEhzd2NmmmF2csenjNMU9fRdGoO8XV-j173mMyZaA6RATvQUfbEmI3mII-5Lpr1DuaX8fR_DRYcE22BzyG3pFPy9jCVWPHCT6tSz-8JI8G-yY4dVDPSffbq7v-o_V5suHT_3VpnKy6UqlwdfDoFvXQa1rpTrdiFZ7xhz3FtpWCgtb5zW-tnUcWKvFVsmGe6Wc5Y2S5-T1ae-c4o8FcjFTyA7G0e4hLtmIrtNad00nEG1OqEMPOcFg5hQmmw6GM3MUb3bmUbw5ij_mKB4HLx5uLNsJ_L-xR9MIvD0BgJ_-DJBMdijNocQErhgfw_9u_AVyv5nz</recordid><startdate>202403</startdate><enddate>202403</enddate><creator>Rauh, Jessica</creator><creator>Dantes, Goeto</creator><creator>Wallace, Marshall</creator><creator>Collings, Amelia</creator><creator>Sanin, Gloria D.</creator><creator>Cambronero, Gabriel E.</creator><creator>Bosley, Maggie E.</creator><creator>Ganapathy, Aravindh S.</creator><creator>Patterson, James W.</creator><creator>Ignacio, Romeo</creator><creator>Knod, Jennifer Leslie</creator><creator>Slater, Bethany</creator><creator>Callier, Kylie</creator><creator>Livingston, Michael H.</creator><creator>Alemayehu, Hanna</creator><creator>Dukleska, Katerina</creator><creator>Scholz, Stefan</creator><creator>Santore, Matthew T.</creator><creator>Zamora, Irving J.</creator><creator>Neff, Lucas P.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1683-9786</orcidid><orcidid>https://orcid.org/0000-0001-7259-8679</orcidid><orcidid>https://orcid.org/0009-0000-8731-0084</orcidid><orcidid>https://orcid.org/0009-0005-3487-3074</orcidid><orcidid>https://orcid.org/0000-0003-4534-0116</orcidid><orcidid>https://orcid.org/0000-0002-9627-4334</orcidid><orcidid>https://orcid.org/0000-0002-5203-3352</orcidid><orcidid>https://orcid.org/0009-0000-9640-9625</orcidid><orcidid>https://orcid.org/0000-0002-3397-6208</orcidid><orcidid>https://orcid.org/0000-0001-8466-1700</orcidid><orcidid>https://orcid.org/0000-0002-3475-3444</orcidid><orcidid>https://orcid.org/0000-0002-8815-1262</orcidid><orcidid>https://orcid.org/0000-0001-6398-7170</orcidid></search><sort><creationdate>202403</creationdate><title>Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis: A Multi-Center Study</title><author>Rauh, Jessica ; Dantes, Goeto ; Wallace, Marshall ; Collings, Amelia ; Sanin, Gloria D. ; Cambronero, Gabriel E. ; Bosley, Maggie E. ; Ganapathy, Aravindh S. ; Patterson, James W. ; Ignacio, Romeo ; Knod, Jennifer Leslie ; Slater, Bethany ; Callier, Kylie ; Livingston, Michael H. ; Alemayehu, Hanna ; Dukleska, Katerina ; Scholz, Stefan ; Santore, Matthew T. ; Zamora, Irving J. ; Neff, Lucas P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-9ed4ff97c8e49455896279d00c1dae7732aebcd9701bc1e0792b5361d55ca1653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Child</topic><topic>Cholangiopancreatography, Endoscopic Retrograde</topic><topic>Cholecystectomy, Laparoscopic</topic><topic>Choledocholithiasis</topic><topic>Choledocholithiasis - surgery</topic><topic>Common Bile Duct - surgery</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>LTCBDE</topic><topic>Pediatric</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rauh, Jessica</creatorcontrib><creatorcontrib>Dantes, Goeto</creatorcontrib><creatorcontrib>Wallace, Marshall</creatorcontrib><creatorcontrib>Collings, Amelia</creatorcontrib><creatorcontrib>Sanin, Gloria D.</creatorcontrib><creatorcontrib>Cambronero, Gabriel E.</creatorcontrib><creatorcontrib>Bosley, Maggie E.</creatorcontrib><creatorcontrib>Ganapathy, Aravindh S.</creatorcontrib><creatorcontrib>Patterson, James W.</creatorcontrib><creatorcontrib>Ignacio, Romeo</creatorcontrib><creatorcontrib>Knod, Jennifer Leslie</creatorcontrib><creatorcontrib>Slater, Bethany</creatorcontrib><creatorcontrib>Callier, Kylie</creatorcontrib><creatorcontrib>Livingston, Michael H.</creatorcontrib><creatorcontrib>Alemayehu, Hanna</creatorcontrib><creatorcontrib>Dukleska, Katerina</creatorcontrib><creatorcontrib>Scholz, Stefan</creatorcontrib><creatorcontrib>Santore, Matthew T.</creatorcontrib><creatorcontrib>Zamora, Irving J.</creatorcontrib><creatorcontrib>Neff, Lucas P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rauh, Jessica</au><au>Dantes, Goeto</au><au>Wallace, Marshall</au><au>Collings, Amelia</au><au>Sanin, Gloria D.</au><au>Cambronero, Gabriel E.</au><au>Bosley, Maggie E.</au><au>Ganapathy, Aravindh S.</au><au>Patterson, James W.</au><au>Ignacio, Romeo</au><au>Knod, Jennifer Leslie</au><au>Slater, Bethany</au><au>Callier, Kylie</au><au>Livingston, Michael H.</au><au>Alemayehu, Hanna</au><au>Dukleska, Katerina</au><au>Scholz, Stefan</au><au>Santore, Matthew T.</au><au>Zamora, Irving J.</au><au>Neff, Lucas P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis: A Multi-Center Study</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>2024-03</date><risdate>2024</risdate><volume>59</volume><issue>3</issue><spage>389</spage><epage>392</epage><pages>389-392</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><abstract>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.
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.
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).
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.
Level III.
•This is the first multi-center retrospective study comparing operative first verses operative second approach in pediatric patients with choledocholithiasis.•Management of choledocholithiasis with upfront LC + IOC ± LCBDE is associated with decreased LOS and reduced need for a second procedure. Postoperative ERCP remains an essential adjunct for patients who fail duct clearance with LCBDE.•Further educational efforts are needed to increase familiarity and the adoption of IOC and LCBDE in pediatric patients with suspected choledocholithiasis.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37957103</pmid><doi>10.1016/j.jpedsurg.2023.10.046</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0003-1683-9786</orcidid><orcidid>https://orcid.org/0000-0001-7259-8679</orcidid><orcidid>https://orcid.org/0009-0000-8731-0084</orcidid><orcidid>https://orcid.org/0009-0005-3487-3074</orcidid><orcidid>https://orcid.org/0000-0003-4534-0116</orcidid><orcidid>https://orcid.org/0000-0002-9627-4334</orcidid><orcidid>https://orcid.org/0000-0002-5203-3352</orcidid><orcidid>https://orcid.org/0009-0000-9640-9625</orcidid><orcidid>https://orcid.org/0000-0002-3397-6208</orcidid><orcidid>https://orcid.org/0000-0001-8466-1700</orcidid><orcidid>https://orcid.org/0000-0002-3475-3444</orcidid><orcidid>https://orcid.org/0000-0002-8815-1262</orcidid><orcidid>https://orcid.org/0000-0001-6398-7170</orcidid></addata></record> |
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| ispartof | Journal of pediatric surgery, 2024-03, Vol.59 (3), p.389-392 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Child Cholangiopancreatography, Endoscopic Retrograde Cholecystectomy, Laparoscopic Choledocholithiasis Choledocholithiasis - surgery Common Bile Duct - surgery Humans Length of Stay LTCBDE Pediatric Retrospective Studies |
| title | Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis: A Multi-Center Study |
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