Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis: A Multi-Center Study.

Autor: Rauh J; Wake Forest School of Medicine, Winston Salem, USA. Electronic address: j.rauh@wakehealth.edu., Dantes G; Childrens Healthcare of Atlanta, Atlanta, USA., Wallace M; Vanderbilt School of Medicine, Nashville, USA., Collings A; University of Louisville, Louisville, USA., Sanin GD; Wake Forest School of Medicine, Winston Salem, USA., Cambronero GE; Wake Forest School of Medicine, Winston Salem, USA., Bosley ME; Wake Forest School of Medicine, Winston Salem, USA., Ganapathy AS; Wake Forest School of Medicine, Winston Salem, USA., Patterson JW; Wake Forest School of Medicine, Winston Salem, USA., Ignacio R; Rady Children's Hospital-San Diego, San Diego, USA., Knod JL; Connecticut Children's, Hartford, USA., Slater B; University of Chicago, Chicago, USA., Callier K; University of Chicago, Chicago, USA., Livingston MH; McMaster University, Ontario, Canada., Alemayehu H; Childrens Healthcare of Atlanta, Atlanta, USA., Dukleska K; Connecticut Children's, Hartford, USA., Scholz S; UPMC, Pittsburgh, USA., Santore MT; Childrens Healthcare of Atlanta, Atlanta, USA., Zamora IJ; Vanderbilt School of Medicine, Nashville, USA., Neff LP; Wake Forest School of Medicine, Winston Salem, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Mar; Vol. 59 (3), pp. 389-392. Date of Electronic Publication: 2023 Oct 21.
DOI: 10.1016/j.jpedsurg.2023.10.046
Abstrakt: 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.
Level of Evidence: Level III.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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