Patient Safety and Radiation Exposure in Transcystic Laparoscopic Common Bile Duct Exploration: A CARES Working Group Multicenter Study.

Autor: Rauh JL; Wake Forest School of Medicine, Winston Salem, USA. Electronic address: j.rauh@wakehealth.edu., Wood EC; Wake Forest School of Medicine, Winston Salem, USA., Dantes G; Childrens Healthcare of Atlanta, Atlanta, USA., Alemayehu H; Childrens Healthcare of Atlanta, Atlanta, USA., Wallace M; Vanderbilt School of Medicine, Nashville, USA., Zamora IJ; Vanderbilt School of Medicine, Nashville, USA., Callier K; University of Chicago, Chicago, USA., Slater BJ; University of Chicago, Chicago, USA., Witte A; Medical College of Wisconsin, USA., Flynn-O-Brien K; Medical College of Wisconsin, USA., Patwardhan UM; Rady Children's Hospital-San Diego, San Diego, USA., Neff L; Wake Forest School of Medicine, Winston Salem, USA., Ignacio R; Rady Children's Hospital-San Diego, San Diego, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Dec; Vol. 59 (12), pp. 161669. Date of Electronic Publication: 2024 Aug 06.
DOI: 10.1016/j.jpedsurg.2024.08.009
Abstrakt: Background: Treatment of choledocholithiasis with laparoscopic cholecystectomy (LC) and intraoperative cholangiogram (IOC) ± transcystic laparoscopic common bile duct exploration (LCBDE) is associated with fewer procedures and shorter length of stay (LOS) compared to preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by LC. Fluoroscopy is required for both LCBDE and ERCP but fluoroscopic time (FT) and radiation dose (RD) in LCBDE has not been studied.
Methods: The Choledocholithiasis Alliance for Research, Education, and Surgery (CARES) Working Group conducted this retrospective study on pediatric patients with suspected choledocholithiasis who received IOC. Demographics, type of LCBDE, FT and RD during IOC ± LCBDE, were analyzed. Statistical analysis was completed using Microsoft Excel and R software.
Results: From five centers, 157 patients were identified (79 without LCBDE, 78 with LCBDE). Wire access into the duodenum was successful in 67 patients (86%) and 64 patients (82%) had successful duct clearance. Median FT for all LCBDE cases was 3.3 min [1.6, 6.7] and RD was 59.8 mGy [30.1, 125.0] with no difference between successful and unsuccessful duct clearance (66.7 mGy [29.0, 115.0], 55.8 mGy [35.8, 154.1], respectfully; p = 0.51).
Conclusion: Although both ERCP and LCBDE approaches result in fluoroscopic radiation exposure, FT, and RD in LCBDE have not previously been studied and are inadequately described in ERCP. Limiting radiation exposure in children is essential and fluoroscopy stewardship is a key component of pediatric safety in LCBDE.
Level of Evidence: Level III.
Competing Interests: Conflict of interest None.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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