Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients

Infographic · Jan 2025 · 1 min read

In brief

Multi-institutional study comparing laparoscopic common bile duct exploration (LCBDE) outcomes in 333 pediatric and 391 adult patients with choledocholithiasis found higher success rates in children (82.1% vs 71.4%) with no increased surgical complications. Results support surgery-first approach with LCBDE as equally effective in pediatric patients despite historical hesitation.

LCBDE success rate was higher in pediatric patients (82.1%) compared to adults (71.4%), with no increase in surgical complications.
Surgery-first approach with LCBDE is underutilized in children (41.7% attempted) compared to adults (82.8%) despite superior outcomes.
Pediatric patients undergoing ERCP-first had significantly higher endoscopic complication rates (9.1% vs 3.6% in adults).
Limited ERCP access in children combined with high LCBDE success rates supports adopting surgery-first approach for pediatric choledocholithiasis.
Technical concerns about LCBDE in children appear unfounded—pediatric surgeons can anticipate equal or better stone clearance than in adults.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with illustrated diagrams of surgical procedures. Each column contains anatomical drawings in blue and pink tones showing the esophagus and stomach, accompanied by bullet-pointed text describing outcomes. The layout uses a clean, educational design with icons and percentage statistics highlighted in colored boxes.

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.

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