Cholelithiasis
Everything in the library about cholelithiasis — built automatically from the recorded discussions that name it
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
Diagnosis & Workup
1 item
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
Surgical Management
3 items
StayCurrent Forums - Laparoscopic Cholecystectomy
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Jeffrey Ponsky, Professor Emeritus of Surgery and Nathaniel Soper, Chairman of Surgery, go back to the basics on Laparoscopic Cholecystectomy on this episode of the StayCurrent Forum.
video16:04 · Apr 2022
Update Course 2021: THORACOTOMY VS VATS FOR OSTEO METS
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The management of lung metastases in osteosarcoma may necessitate deciding approach–either thoracotomy or VATS. At the 2021 Pediatric Surgery Update Course, Dr. Anusua "Roshni" Dasgupta, MD reviewed the latest literature.
video · May 2022
Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024
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Welcome to the 12th Annual Update Course in Pediatric Surgery recap series, hosted by Dr. Em Gootee from Cincinnati Children’s Hospital. In this Green Circle (established practice) session, Drs. David Vitale, Luke Neff, and Jeff Ponsky expl
video7:31 · Jul 2025
Case-Based Learning
1 item
Case-Based Journal Review: Cholelithiasis 2024
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It is already public knowledge that thousands of articles on different pathologies are published every day and that it is very difficult to follow them.
In this format we bring you a different way of knowing what is the most up-to-date o
podcast18:12 · Jul 2024
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Update Course 2021: THORACOTOMY VS VATS FOR OSTEO METS
In adult centers, surgeons perform 100 to 300 cholecystectomies per year compared to 10 to 30 per year in pediatric centers
epidemiologicalChiro Esposito3:34 ↗
ICG is a soluble molecule that rapidly binds to albumin and is removed from circulation by the liver into bile juice
clinicalChiro Esposito0:23 ↗
For cholecystectomy, ICG must be injected 12 to 15 hours preoperatively to allow secretion into bile juice for selective biliary tree visualization
clinicalChiro Esposito7:15 ↗
If ICG is injected intraoperatively for cholecystectomy, the liver takes up the dye and appears green, making gallbladder identification difficult
clinicalChiro Esposito7:51 ↗
For all ICG indications except cholecystectomy (kidney, varicocele, lymphoma, tumors), the injection is given intraoperatively
clinicalChiro Esposito7:51 ↗
ICG vial contains 25 mg in 4 ml, diluted with 10 ml sterile water, with 6 ml injected intravenously for cholecystectomy
clinicalChiro Esposito4:40 ↗
For partial nephrectomy in duplex kidney, ICG is injected three times: via ureteral catheter to identify normal ureter, intravenously to visualize kidney vasculature, and intravenously again after vessel clipping to show devascularization line
clinicalChiro Esposito9:34 ↗
In duplex kidney with reflux, the two ureters are attached to each other, making identification of the normal ureter difficult without ICG
clinicalChiro Esposito9:34 ↗
For varicocele repair, intratesticular injection of 2 ml ICG solution allows intraoperative fluorescence lymphography to identify and spare lymphatic vessels
clinicalChiro Esposito17:30 ↗
Palomo varicocele repair has success rate of more than 97-98% but ligating lymphatics in the spermatic bundle causes postoperative hydrocele in about 20% of cases
clinicalChiro Esposito17:30 ↗
In a series of more than 150 varicocele patients using ICG lymphatic sparing technique, there were zero postoperative hydroceles
clinicalChiro Esposito19:10 ↗
The spermatic bundle contains three to four lymphatic vessels
clinicalChiro Esposito17:30 ↗
There is no maximum dose limit for ICG based on adult surgery studies
clinicalChiro Esposito21:53 ↗
ICG vial remains usable for six hours after preparation
clinicalChiro Esposito21:24 ↗
No adverse effects of ICG were observed in the presenter's experience
clinicalChiro Esposito21:24 ↗
ICG technology can be used in both laparoscopy (requiring special camera and optic) and robotic surgery with Da Vinci XI Firefly system
clinicalChiro Esposito1:20 ↗
The newer Rubin ICG system allows visualization in color with biliary tree appearing green, compared to older systems showing black and white images
clinicalChiro Esposito5:40 ↗
For elective cholecystectomy cases, patients are hospitalized the day before surgery for ICG injection in the late afternoon if surgery is scheduled early morning
clinicalChiro Esposito8:42 ↗
ICG technology helps reduce complications in laparoscopic cholecystectomy, particularly beneficial for trainees and in centers with longer learning curves due to lower case volumes
opinionChiro Esposito3:34 ↗
Case-Based Journal Review: Cholelithiasis 2024
Chile has the highest rate of cholelithiasis globally
epidemiologicalJose Campos1:07 ↗
In a multi-center study of 167 early cholecystectomy patients versus 79 delayed, early cholecystectomy had 2% recurrence of pancreatitis compared to 22% in delayed surgery
host_summaryCecilia Gigena3:11 ↗
When cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%
host_summaryCecilia Gigena3:36 ↗
Even in patients with no stones remaining, 2% will get recurrent pancreatitis from the initial insult
clinicalTodd Ponsky3:44 ↗
Patients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients
host_summaryCecilia Gigena4:27 ↗
When patients present with gallstone pancreatitis, most pain and elevated enzymes occur as the stone is passing, and symptoms often resolve overnight as the stone passes
clinicalTodd Ponsky5:01 ↗
If laboratory values normalize after gallstone pancreatitis, ERCP is not indicated, but intraoperative cholangiogram should be performed to check for additional stones
clinicalTodd Ponsky5:36 ↗
A Western Pediatric Surgery Research Consortium machine learning algorithm based on 1600 patients from 10 centers (2016-2019) can predict common bile duct stones using nine clinical factors, with 20% of patients having CBD stones
host_summaryEm Gootee6:26 ↗
The machine learning algorithm for predicting CBD stones has a negative predictive value of 98%, meaning only 2% chance of missing stones when algorithm predicts low risk
host_summaryJose Campos7:11 ↗
The previous algorithm for predicting CBD stones was based on 300-400 patients, compared to 1600 in the new algorithm
host_summaryEm Gootee7:33 ↗
For patients with impacted stone, rising lipase, and worsening jaundice, ERCP is preferred because surgeon confidence in retrieving impacted stones intraoperatively is lower
opinionTodd Ponsky8:58 ↗
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