Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis

Infographic · May 2024 · 1 min read

In brief

Multi-center study comparing upfront laparoscopic cholecystectomy with transcystic bile duct exploration versus preoperative ERCP in 252 pediatric choledocholithiasis patients. The surgery-first approach achieved 86% definitive treatment, reduced hospital stay (2.39 vs 3.84 days), and fewer complications compared to ERCP-first strategy.

Upfront laparoscopic cholecystectomy with intraoperative cholangiogram ± transcystic LCBDE reduces length of stay vs preoperative ERCP approach
86% of pediatric choledocholithiasis cases achieved definitive intraoperative management with transcystic LCBDE, avoiding need for ERCP
OR-first strategy associated with fewer complications (1.9% vs 15.6%) compared to preoperative ERCP followed by cholecystectomy
Postoperative ERCP remains necessary adjunct for 14% of patients who fail intraoperative transcystic common bile duct exploration
Increased training in IOC and LCBDE techniques needed to expand adoption of upfront surgical approach in pediatric choledocholithiasis

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with accompanying text boxes below describing outcomes. The left column shows balloon dilation, the middle shows Heller myotomy, and the right shows POEM procedure. Success rates are prominently displayed with percentage values.

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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