Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients
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- Surgery-first approach (laparoscopic cholecystectomy with IOC) was performed in 201 pediatric and 169 adult choledocholithiasis patients (2018-2024).
- Laparoscopic common bile duct exploration was attempted in 84 children and 140 adults, with higher success rates in pediatric patients.
- Complication rates were similar between pediatric and adult patients undergoing surgery-first management.
- Surgery-first approach appears safe and effective for pediatric choledocholithiasis, potentially avoiding preoperative ERCP.
- Multi-center data (724 patients) supports upfront surgical management as a viable option in children with common bile duct stones.
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Can a surgery first approach be used for the management of cholodocholithiasis in children? I'm Alex Halpern, a research fellow from Children's National, and this is an article that you should know. To try and answer this question, Dantesetal performed a multi-center retrospective review looking at pediatric and adult patients treated for cholodocholithiasis between 2018 and 2024. 724 patients were included. The surgery first approach with upfront laparoscopic cholecystectomy with intraoperative cholangiogram was performed in 201 pediatric patients and 169 adult patients. In the surgery first group, laparoscopic common bile duct exploration was attempted in 84 kids and 140 adults. Common bile duct exploration success was higher in pediatric than adult patients with similar complication rates. So it seems like a surgery first approach can be a safe and effective tool for managing chodocholithiasis in pediatric patients. Does this information change your practice? Let us know what you think in the comments below.