Pub Date : 2025-06-29DOI: 10.1016/j.sempedsurg.2025.151497
Micaela K. Gomez , Maggie E. Bosley
The incidence of pediatric gallstone disease has increased significantly in recent years. Laparoscopic cholecystectomy is the standard of care for symptomatic and complicated gallstone disease. In cases of choledocholithiasis, ductal clearance can be achieved with either endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopic common bile duct exploration (LCBDE). Here we review the complications associated with each treatment modality. A clear understanding of procedure-specific risks in children is needed to inform evidence-based treatment pathways and optimize outcomes.
{"title":"Endoscopic and surgical approaches in the management of pediatric gallstone disease: A review of associated complications","authors":"Micaela K. Gomez , Maggie E. Bosley","doi":"10.1016/j.sempedsurg.2025.151497","DOIUrl":"10.1016/j.sempedsurg.2025.151497","url":null,"abstract":"<div><div>The incidence of pediatric gallstone disease has increased significantly in recent years. Laparoscopic cholecystectomy is the standard of care for symptomatic and complicated gallstone disease. In cases of choledocholithiasis, ductal clearance can be achieved with either endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopic common bile duct exploration (LCBDE). Here we review the complications associated with each treatment modality. A clear understanding of procedure-specific risks in children is needed to inform evidence-based treatment pathways and optimize outcomes.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151497"},"PeriodicalIF":1.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-29DOI: 10.1016/j.sempedsurg.2025.151502
Arianna Kahler-Quesada , Insiyah Campwala , Stefan Scholz
Gallstone pancreatitis is an increasingly recognized pathology in the pediatric population, and there has been work done in the scientific community to create consensus guidelines regarding management. While historically attributed to hemolytic diseases, cholelithiasis in children is increasingly being attributed to childhood obesity, oral contraceptive pill (OCP) use, and pregnancy. At this time, guidelines are largely based on adult management protocols that are safe and effective in the pediatric population: fluid resuscitation with crystalloid, early enteral feeding, management of choledocholithiasis with endoscopic retrograde cholangiopancreatography (ERCP) with gastroenterology or a “Surgery-first” approach with optional common bile duct exploration at time of cholecystectomy, and cholecystectomy during index admission. However, continued work is needed to create more precise guidelines for the pediatric population.
{"title":"Management of gallstone pancreatitis in children","authors":"Arianna Kahler-Quesada , Insiyah Campwala , Stefan Scholz","doi":"10.1016/j.sempedsurg.2025.151502","DOIUrl":"10.1016/j.sempedsurg.2025.151502","url":null,"abstract":"<div><div>Gallstone pancreatitis is an increasingly recognized pathology in the pediatric population, and there has been work done in the scientific community to create consensus guidelines regarding management. While historically attributed to hemolytic diseases, cholelithiasis in children is increasingly being attributed to childhood obesity, oral contraceptive pill (OCP) use, and pregnancy. At this time, guidelines are largely based on adult management protocols that are safe and effective in the pediatric population: fluid resuscitation with crystalloid, early enteral feeding, management of choledocholithiasis with endoscopic retrograde cholangiopancreatography (ERCP) with gastroenterology or a “Surgery-first” approach with optional common bile duct exploration at time of cholecystectomy, and cholecystectomy during index admission. However, continued work is needed to create more precise guidelines for the pediatric population.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151502"},"PeriodicalIF":1.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-29DOI: 10.1016/j.sempedsurg.2025.151501
Wesley Judy , Micaela K Gomez , Quin Liu , Lucas Neff
Pediatric choledocholithiasis is a rare but increasingly recognized disease process that is predominantly managed with either an “endoscopy-first” or “surgery-first” (SF) approach. In the endoscopy-first approach, a preoperative endoscopic retrograde cholangiopancreatography is performed with subsequent cholecystectomy. In contrast, the surgery-first approach is a single-stage procedure that includes a laparoscopic cholecystectomy and intraoperative cholangiogram, followed by a laparoscopic common bile duct exploration when indicated. Recent studies have highlighted the potential advantages of the SF approach. However, no standardized treatment algorithm exists, and institutional capabilities and practicing patterns heavily influence management decisions. This point-counterpoint review explores both approaches, analyzing their effects on clinical outcomes and healthcare resources. Continued research and a multidisciplinary approach are needed to develop consensus-driven treatment algorithms.
{"title":"ERCP first vs. surgery first: A comparative perspective in pediatric choledocholithiasis","authors":"Wesley Judy , Micaela K Gomez , Quin Liu , Lucas Neff","doi":"10.1016/j.sempedsurg.2025.151501","DOIUrl":"10.1016/j.sempedsurg.2025.151501","url":null,"abstract":"<div><div>Pediatric choledocholithiasis is a rare but increasingly recognized disease process that is predominantly managed with either an “endoscopy-first” or “surgery-first” (SF) approach. In the endoscopy-first approach, a preoperative endoscopic retrograde cholangiopancreatography is performed with subsequent cholecystectomy. In contrast, the surgery-first approach is a single-stage procedure that includes a laparoscopic cholecystectomy and intraoperative cholangiogram, followed by a laparoscopic common bile duct exploration when indicated. Recent studies have highlighted the potential advantages of the SF approach. However, no standardized treatment algorithm exists, and institutional capabilities and practicing patterns heavily influence management decisions. This point-counterpoint review explores both approaches, analyzing their effects on clinical outcomes and healthcare resources. Continued research and a multidisciplinary approach are needed to develop consensus-driven treatment algorithms.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151501"},"PeriodicalIF":1.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-28DOI: 10.1016/j.sempedsurg.2025.151493
Alicia C. Greene, Robert Ricca
Cholelithiasis and its associated conditions are increasingly encountered by pediatric surgeons. Multiple factors contribute to the increase in prevalence of cholelithiasis in children as well as the increasing need for intervention due to symptomatic cholelithiasis and the associated complications including gallstone pancreatitis and choledocholithiasis. Surgeons are often called on to manage these conditions operatively. However, many times pediatric surgeons may be consulted early in the clinical course when these biliary stones are found incidentally and are asymptomatic or minimally symptomatic. Additional complicating factors, such as comorbidities or younger age, may render these potential surgical patients suboptimal candidates for surgical management. It is therefore important that pediatric surgeons have a basic understanding of the options for non-operative or medical management of these patients. While this issue of Seminars in Surgery will primarily focus on the surgical management of biliary stone disease given the audience of pediatric surgeons, this section will provide a brief review of non-operative management strategies for pediatric patients presenting with cholelithiasis or one of its complications.
{"title":"Medical management of biliary stone disease in pediatric patients","authors":"Alicia C. Greene, Robert Ricca","doi":"10.1016/j.sempedsurg.2025.151493","DOIUrl":"10.1016/j.sempedsurg.2025.151493","url":null,"abstract":"<div><div>Cholelithiasis and its associated conditions are increasingly encountered by pediatric surgeons. Multiple factors contribute to the increase in prevalence of cholelithiasis in children as well as the increasing need for intervention due to symptomatic cholelithiasis and the associated complications including gallstone pancreatitis and choledocholithiasis. Surgeons are often called on to manage these conditions operatively. However, many times pediatric surgeons may be consulted early in the clinical course when these biliary stones are found incidentally and are asymptomatic or minimally symptomatic. Additional complicating factors, such as comorbidities or younger age, may render these potential surgical patients suboptimal candidates for surgical management. It is therefore important that pediatric surgeons have a basic understanding of the options for non-operative or medical management of these patients. While this issue of Seminars in Surgery will primarily focus on the surgical management of biliary stone disease given the audience of pediatric surgeons, this section will provide a brief review of non-operative management strategies for pediatric patients presenting with cholelithiasis or one of its complications.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151493"},"PeriodicalIF":1.4,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-17DOI: 10.1016/j.sempedsurg.2025.151472
Jie Zhu, Bin Wu, Peng Cai, Jiang Pan, Zhenwei Zhu
This article has been withdrawn at the request of the Editor. This manuscript is completing the peer review process. It will be available when the peer review is completed, and it is accepted for publication. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
{"title":"WITHDRAWN: Surgical Strategies for Biliary Atresia in Children: A Meta-Analysis of Laparoscopic and Open Techniques.","authors":"Jie Zhu, Bin Wu, Peng Cai, Jiang Pan, Zhenwei Zhu","doi":"10.1016/j.sempedsurg.2025.151472","DOIUrl":"10.1016/j.sempedsurg.2025.151472","url":null,"abstract":"<p><p>This article has been withdrawn at the request of the Editor. This manuscript is completing the peer review process. It will be available when the peer review is completed, and it is accepted for publication. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.</p>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":" ","pages":"151472"},"PeriodicalIF":2.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.sempedsurg.2025.151473
Iiris Nyholm , Maria Hukkinen , Mikko P Pakarinen
Regardless of the underlying etiology and success of PE, progressive liver fibrosis and eventually cirrhosis represent the dominant pathology and the end-stage of BA. Ascending bile duct injury-induced cholestasis, inflammation and ductular reaction provide profibrogenic cytokine environment leading to myofibroblast activation and rapid progression of fibrosis especially after unsuccessful portoenterostomy. Although liver fibrosis and development of cirrhosis play a crucial role in determining BA outcomes, the exact prognostic significance and dynamics of mild to moderate liver fibrosis remain unclear. Manual scoring systems categorizing the degree of liver fibrosis are prone to intra- and interobserver variability, whereas novel combinations of digital pathology with artificial intelligence quantification can provide accurate information on fibrosis structure and dynamics at the level of individual collagen fibers. Although several studies have analyzed noninvasive assessment of fibrosis at time of PE, including imaging-based elastography and different serum biomarkers, current knowledge on their accuracy during the postoperative follow-up of BA is scarce. While therapeutic management of liver fibrosis in BA remains in its infancy, the resolution potential for liver fibrosis has been demonstrated after successful PE. Achievement of effective antifibrotic treatment may require combination of different therapies with complementary modes of action like anti-inflammatory medication, antioxidants and bile acid lowering agents.
{"title":"Predicting and managing liver fibrosis in biliary atresia","authors":"Iiris Nyholm , Maria Hukkinen , Mikko P Pakarinen","doi":"10.1016/j.sempedsurg.2025.151473","DOIUrl":"10.1016/j.sempedsurg.2025.151473","url":null,"abstract":"<div><div>Regardless of the underlying etiology and success of PE, progressive liver fibrosis and eventually cirrhosis represent the dominant pathology and the end-stage of BA. Ascending bile duct injury-induced cholestasis, inflammation and ductular reaction provide profibrogenic cytokine environment leading to myofibroblast activation and rapid progression of fibrosis especially after unsuccessful portoenterostomy. Although liver fibrosis and development of cirrhosis play a crucial role in determining BA outcomes, the exact prognostic significance and dynamics of mild to moderate liver fibrosis remain unclear. Manual scoring systems categorizing the degree of liver fibrosis are prone to intra- and interobserver variability, whereas novel combinations of digital pathology with artificial intelligence quantification can provide accurate information on fibrosis structure and dynamics at the level of individual collagen fibers. Although several studies have analyzed noninvasive assessment of fibrosis at time of PE, including imaging-based elastography and different serum biomarkers, current knowledge on their accuracy during the postoperative follow-up of BA is scarce. While therapeutic management of liver fibrosis in BA remains in its infancy, the resolution potential for liver fibrosis has been demonstrated after successful PE. Achievement of effective antifibrotic treatment may require combination of different therapies with complementary modes of action like anti-inflammatory medication, antioxidants and bile acid lowering agents.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 6","pages":"Article 151473"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.sempedsurg.2025.151470
Allen Zhong, Kasper S. Wang
{"title":"Seminars in pediatric surgery: Preface for updates in biliary atresia","authors":"Allen Zhong, Kasper S. Wang","doi":"10.1016/j.sempedsurg.2025.151470","DOIUrl":"10.1016/j.sempedsurg.2025.151470","url":null,"abstract":"","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 6","pages":"Article 151470"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143227485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.sempedsurg.2025.151479
Renos M. Jeropoulos, Jorge Arroyo, Mark Davenport
Biliary atresia (BA) remains a disease of significant morbidity and mortality world-wide. Early and accurate diagnosis facilitates early intervention and improves outcomes. The gold standard in diagnosing BA is a liver biopsy followed by cholangiography, usually performed intra-operatively. Serum markers, like the aspartate aminotransferase-to-platelet ratio, matrix metalloproteinase-7 and several inflammatory cytokines have been recently investigated as non-invasive alternatives with varying degrees of success. Newer immunohistochemical analysis of liver biopsies, such as the expression of secretin receptors and Ki-67, from infants with BA have improved our understanding of the disease process and has shed a little light in predicting post-operative outcomes.
There is little standardisation in the care of BA post operatively, though administration of steroids, prevention and treatment of cholangitis with antibiotics and anti-viral therapy for CMV+ve infants are becoming universally accepted as treatment. Experimental stem cell treatments show promise although remain in the out-of-reach future for now in routine clinical practice.
This chapter aims to comprehensively describe recent knowledge on predicting the clinical outcomes of infants with BA, as well as optimising their care post operatively.
{"title":"Predicting and optimising outcome for biliary atresia","authors":"Renos M. Jeropoulos, Jorge Arroyo, Mark Davenport","doi":"10.1016/j.sempedsurg.2025.151479","DOIUrl":"10.1016/j.sempedsurg.2025.151479","url":null,"abstract":"<div><div>Biliary atresia (BA) remains a disease of significant morbidity and mortality world-wide. Early and accurate diagnosis facilitates early intervention and improves outcomes. The gold standard in diagnosing BA is a liver biopsy followed by cholangiography, usually performed intra-operatively. Serum markers, like the aspartate aminotransferase-to-platelet ratio, matrix metalloproteinase-7 and several inflammatory cytokines have been recently investigated as non-invasive alternatives with varying degrees of success. Newer immunohistochemical analysis of liver biopsies, such as the expression of secretin receptors and Ki-67, from infants with BA have improved our understanding of the disease process and has shed a little light in predicting post-operative outcomes.</div><div>There is little standardisation in the care of BA post operatively, though administration of steroids, prevention and treatment of cholangitis with antibiotics and anti-viral therapy for CMV+ve infants are becoming universally accepted as treatment. Experimental stem cell treatments show promise although remain in the out-of-reach future for now in routine clinical practice.</div><div>This chapter aims to comprehensively describe recent knowledge on predicting the clinical outcomes of infants with BA, as well as optimising their care post operatively.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 6","pages":"Article 151479"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.sempedsurg.2025.151476
Alyssa Stetson, Alexander Bondoc, Greg Tiao
The Kasai portoenterostomy (KPE) can provide a surgical cure for children with biliary atresia (BA), without the need for a liver transplant (OLTxp). Revision KPE can be attempted following a failed initial KPE where biliary clearance is not achieved. The most common indications for revision KPE are recurrent jaundice or recurrent cholangitis, although it has also been performed for persistent jaundice or bile lakes. Outcomes are heterogenous but the best results appear to be with recurrent jaundice or limited episodes of recurrent cholangitis. In the setting of a failed KPE, providers must make a patient-specific decision about whether to attempt revision KPE versus proceed with OLTxp. While the choice is multifactorial, patients who undergo revision KPE likely do not have worse long-term outcomes than patients who undergo a single KPE.
{"title":"Revision Kasai portoenterostomy: A review of indications and outcomes","authors":"Alyssa Stetson, Alexander Bondoc, Greg Tiao","doi":"10.1016/j.sempedsurg.2025.151476","DOIUrl":"10.1016/j.sempedsurg.2025.151476","url":null,"abstract":"<div><div>The Kasai portoenterostomy (KPE) can provide a surgical cure for children with biliary atresia (BA), without the need for a liver transplant (OLTxp). Revision KPE can be attempted following a failed initial KPE where biliary clearance is not achieved. The most common indications for revision KPE are recurrent jaundice or recurrent cholangitis, although it has also been performed for persistent jaundice or bile lakes. Outcomes are heterogenous but the best results appear to be with recurrent jaundice or limited episodes of recurrent cholangitis. In the setting of a failed KPE, providers must make a patient-specific decision about whether to attempt revision KPE versus proceed with OLTxp. While the choice is multifactorial, patients who undergo revision KPE likely do not have worse long-term outcomes than patients who undergo a single KPE.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 6","pages":"Article 151476"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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