Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Hepatobiliary Surgery

Background:

• Choledocholithiasis management in adults often involves upfront intraoperative cholangiogram with laparoscopic common bile duct exploration (LCBDE).
• Hesitation exists in adopting LCBDE as a surgery-first (SF) approach for pediatric choledocholithiasis over ERCP-first (EF) due to perceived technical difficulties.
• This study evaluates LCBDE success rates in pediatric patients compared to adults to address these concerns.

Purpose of the Study:

• To compare the success rates of LCBDE for common bile duct stone clearance between pediatric and adult patients.
• To assess and compare surgical and endoscopic complication rates between pediatric and adult cohorts.
• To provide evidence supporting LCBDE as a viable primary treatment for pediatric choledocholithiasis.

Main Methods:

• A multicenter, retrospective review of pediatric (<18 years) and adult patients diagnosed with choledocholithiasis between 2018 and 2024.
• Data collection included demographics, clinical information, LCBDE success rates, and complication types (infections, bleeding, pancreatitis, bile leak).
• Statistical comparison of LCBDE success and complication rates between pediatric and adult groups was performed.

Main Results:

• A total of 724 patients (333 pediatric, 391 adult) were analyzed. Pediatric patients were significantly younger (median 15.2 years) than adults (median 55.5 years).
• The surgery-first approach was more common in pediatric patients (60.4%) compared to adults (43.2%). LCBDE was attempted more frequently in adults (82.8%) than pediatric patients (41.7%).
• LCBDE demonstrated higher success rates in pediatric patients (82.1%) versus adults (71.4%). Endoscopic complications were higher in pediatric patients undergoing EF (9.1%) compared to adults (3.6%).

Conclusions:

• Laparoscopic common bile duct exploration (LCBDE) is a highly successful procedure for managing choledocholithiasis in children, with success rates comparable to or exceeding those in adults.
• There is no increased risk of surgical complications in pediatric patients undergoing LCBDE.
• Given the high efficacy, safety, and limited availability of pediatric ERCP, LCBDE should be strongly considered as an effective primary treatment for pediatric choledocholithiasis.