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Choledocholithiasis
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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
Patients with deep jaundice or cholangitis (jaundice, fever, right upper quadrant pain, sometimes sepsis) are potential candidates for emergency ERCP to relieve common bile duct obstruction — Jeff Ponsky, Choledocholithiasis: Diagnosis and management · 1:43
Choledocholithiasis: Diagnosis and management
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Despite an abundance of skilled gastroenterologists, the modern day general surgeon still needs to be comfortable operating for common bile duct stones. That's why we talked to Dr. Jeff Ponsky about the keys to diagnosis and management of c
podcast12:11 · Mar 2021
Acute Cholecystitis
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Dr. John Rodriguez, MD Professor of Surgery at Cleveland Clinic Lerner College of Medicine discusses acute cholecystitis with Dr Jeffrey Ponsky, MD Edited by: Harveen Lamba, MD MS Mena Boules, and MD Todd Ponsky
video32:30 · Jun 2026
Acute Cholecystitis
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An interactive discussion about acute cholecystitis disease between Jeffrey Ponsky, MD and John Rodriguez, MD. Dr. Rodriguez is a general surgery staff surgeon
podcast32:28 · Jul 2026
A surgery first approach can be a safe and effective tool for managing choledocholithiasis in pediatric patients — Alex Halpern, Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients · 0:49
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
Local expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration. — David Vitale, Choledocholithiasis with Drs. David Vitale & Lucas Neff · 5:00
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
Expert statements from the recordings in this collection.
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
Alex Halpern0:11
724 patients were included in the study
Alex Halpern0:22
Surgery first approach with upfront laparoscopic cholecystectomy with intraoperative cholangiogram was performed in 201 pediatric patients and 169 adult patients
Alex Halpern0:25
Laparoscopic common bile duct exploration was attempted in 84 children and 140 adults in the surgery first group
Alex Halpern0:35
Common bile duct exploration success was higher in pediatric than adult patients
Alex Halpern0:43
Complication rates were similar between pediatric and adult patients in the surgery first approach
Alex Halpern0:43
A surgery first approach can be a safe and effective tool for managing choledocholithiasis in pediatric patients
Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis
The study was a multi-center retrospective study conducted in the US from 2018 to 2022
The study aim was to compare patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first
The study included 252 patients total
156 patients were in group one (transcystic laparoscopic common bile duct exploration)
96 patients were in group two (ERCP first)
Patients in group one (transcystic laparoscopic approach) had significantly less complication rates compared to group two
Patients in group one (transcystic laparoscopic approach) had lower length of stay compared to group two
Attempting a transcystic laparoscopic common bile duct exploration may benefit pediatric patients with choledocholithiasis
Choledocholithiasis with Drs. David Vitale & Lucas Neff
Choledocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts.
Risk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts.
David Vitale0:55
Choledocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity.
David Vitale1:03
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.
Host summaryDavid Vitale summarizes what Dr. Luke Neff said — not the host's own clinical position1:52
Patients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound.
In pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones.
Host summaryDavid Vitale summarizes what Dr. Luke Neff said — not the host's own clinical position2:40
Common bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance.
The pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL.
Host summaryDavid Vitale summarizes what Dr. Luke Neff said — not the host's own clinical position3:03
Pediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay.
Host summaryDavid Vitale summarizes what Dr. Luke Neff said — not the host's own clinical position3:41
Retrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise.
Randomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration.
Stones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult.
David Vitale4:39
Local expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration.
Most free-standing children's hospitals do not have ERCP capabilities.
Dr. Neff uses a 12-gauge angiocath for access, which may be hard to find in pediatric hospitals but can be ordered.
Luke Neff9:37