Implementation of a Surgery-first Approach to Pediatric Choledocholithiasis

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Hepatobiliary Surgery

Background:

• Choledocholithiasis necessitates common bile duct (CBD) clearance via ERCP or IOC/CBDE during cholecystectomy.
• Comparing primary cholecystectomy (PC) with IOC/CBDE to primary ERCP (PE) may reveal improved clinical outcomes.

Purpose of the Study:

• To compare clinical and cost outcomes between PC and PE cohorts in pediatric choledocholithiasis.
• To assess protocol compliance in managing CBD stones.

Main Methods:

• Retrospective cohort study of pediatric patients with choledocholithiasis (2019-2023).
• Comparison of clinical and cost outcomes between PC and PE groups.
• Assessment of duct-clearing procedures including ERCP, IOC/CBDE, and spontaneous clearance.

Main Results:

• 36 PC patients and 40 PE patients analyzed.
• PC patients showed varied duct-clearing procedures: ERCP (36.1%), IOC/CBDE (36.1%), spontaneous clearance (27.8%).
• No significant differences in cost or admission; PC had longer anesthesia duration (186 vs. 170.5 min).

Conclusions:

• Most PC patients achieved CBD clearance via IOC and spontaneous means.
• PC strategy may allow earlier cholecystectomy and potentially avoid postoperative ERCP.
• Further research on surgery-first protocols is warranted for larger cohorts.