Implementation of a Surgery-first Approach to Pediatric Choledocholithiasis

In choledocholithiasis, the obstructed common bile duct (CBD) requires clearance either via endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiogram (IOC) and common bile duct exploration (CBDE) during cholecystectomy. We hypothesized that patients with primary cholecystectomy (PC) and IOC/CBDE will have improved clinical outcomes when compared to primary ERCP (PE) patients. We performed a retrospective cohort study of pediatric choledocholithiasis patients who underwent treatment at our institution between 2019 and 2023. We compared clinical and cost outcomes between PC and PE cohorts and assessed protocol compliance. We analyzed 36 PC patients and 40 PE patients. Among PC patients, 52.7% underwent postoperative ERCP of which 47.4% were negative for CBD stone. Duct-clearing procedure varied between PC and PE groups, respectively, in terms of ERCP (36.1% vs. 65%), IOC/CBDE (36.1% vs. 2.5%), and spontaneous clearance (27.8 vs. 32.5%) (p