Garrett Reid, Jessica L Rauh, Elizabeth Wood, Goeto Dantes, Matthew T Santore, Marshall W Wallace, Irving J Zamora, Amelia Collings, Kylie Callier, Bethany J Slater, Derek Krinock, Sabina Siddiqui, Robert Vandewalle, Amanda Witte, Katherine Flynn-O-Brien, Utsav M Patwardhan, Romeo C Ignacio, Jennifer Leslie Knod, Katerina Dukleska, Michael H Livingston, Stefan Scholz, Maggie Bosley, Lucas Neff, Hanna Alemayehu
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Because ERCP availability is often limited at the end of the week (EoW), we hypothesized that a \"surgery-first\" (SF) approach (LC with intraoperative cholangiogram (IOC) ± transcystic laparoscopic common bile exploration (LCBDE)) would decrease length of stay (LOS) and time to definitive intervention (TTDI).</p><p><strong>Methods: </strong>A multicenter, retrospective cohort study was conducted on pediatric patients from 2018 to 2023 with suspected choledocholithiasis. Work week (WW) presentation was defined as admission between Monday to Thursday. TTDI was defined as time to LC or postoperative ERCP (if required).</p><p><strong>Results: </strong>Among seven hospitals, there were 354 pediatric patients; 217 (61%) managed with SF (125 WW, 92 EoW) and 137 (39%) managed with EF (74 WW, 63 EoW). SF groups had a shorter LOS for both WW and EoW presentation (60.2 h and 58.3 h vs 88.5 h and 93.6 h respectively; p < 0.05). TTDI decreased in SF (26.4 h and 28.9 h vs 61.4 h and 72.8 h; p < 0.05). All EF patients underwent at least two anesthetics (preoperative ERCP followed by LC) while the majority (79%) of the SF group had only one procedure (LC + IOC ± LCBDE).</p><p><strong>Conclusion: </strong>Children who present with choledocholithiasis at EoW have a longer LOS and TTDI. These findings are amplified when children enter an EF pathway. A surgery-first approach results in fewer procedures, decreased TTDI, and shorter LOS, regardless of the time of presentation.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"161959"},"PeriodicalIF":2.4000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"\\\"Surgery First\\\" vs. \\\"Endoscopy First\\\" for Pediatric Choledocholithiasis Presenting at the End of the Week - A CARES Working Group Study.\",\"authors\":\"Garrett Reid, Jessica L Rauh, Elizabeth Wood, Goeto Dantes, Matthew T Santore, Marshall W Wallace, Irving J Zamora, Amelia Collings, Kylie Callier, Bethany J Slater, Derek Krinock, Sabina Siddiqui, Robert Vandewalle, Amanda Witte, Katherine Flynn-O-Brien, Utsav M Patwardhan, Romeo C Ignacio, Jennifer Leslie Knod, Katerina Dukleska, Michael H Livingston, Stefan Scholz, Maggie Bosley, Lucas Neff, Hanna Alemayehu\",\"doi\":\"10.1016/j.jpedsurg.2024.161959\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Choledocholithiasis in children is commonly managed with an \\\"endoscopy-first\\\" (EF) strategy (endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC)). Because ERCP availability is often limited at the end of the week (EoW), we hypothesized that a \\\"surgery-first\\\" (SF) approach (LC with intraoperative cholangiogram (IOC) ± transcystic laparoscopic common bile exploration (LCBDE)) would decrease length of stay (LOS) and time to definitive intervention (TTDI).</p><p><strong>Methods: </strong>A multicenter, retrospective cohort study was conducted on pediatric patients from 2018 to 2023 with suspected choledocholithiasis. Work week (WW) presentation was defined as admission between Monday to Thursday. TTDI was defined as time to LC or postoperative ERCP (if required).</p><p><strong>Results: </strong>Among seven hospitals, there were 354 pediatric patients; 217 (61%) managed with SF (125 WW, 92 EoW) and 137 (39%) managed with EF (74 WW, 63 EoW). SF groups had a shorter LOS for both WW and EoW presentation (60.2 h and 58.3 h vs 88.5 h and 93.6 h respectively; p < 0.05). TTDI decreased in SF (26.4 h and 28.9 h vs 61.4 h and 72.8 h; p < 0.05). All EF patients underwent at least two anesthetics (preoperative ERCP followed by LC) while the majority (79%) of the SF group had only one procedure (LC + IOC ± LCBDE).</p><p><strong>Conclusion: </strong>Children who present with choledocholithiasis at EoW have a longer LOS and TTDI. These findings are amplified when children enter an EF pathway. 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引用次数: 0
摘要
背景：儿童胆总管结石通常采用 "内镜先行"（EF）策略（内镜逆行胰胆管造影（ERCP），然后进行腹腔镜胆囊切除术（LC））进行治疗。由于ERCP在周末（EoW）的可用性往往有限，我们假设 "手术先行"（SF）方法（LC加术中胆管造影（IOC）±经囊腹腔镜胆总管探查（LCBDE））将缩短住院时间（LOS）和明确干预时间（TTDI）：对2018年至2023年疑似胆总管结石的儿科患者进行了一项多中心、回顾性队列研究。工作周（WW）发病定义为周一至周四入院。TTDI定义为到LC或术后ERCP（如需要）的时间：结果：七家医院共收治了354名儿科患者，其中217人（61%）采用顺式手术（125人WW，92人EoW），137人（39%）采用英式手术（74人WW，63人EoW）。SF组的WW和EoW病例的住院时间均较短（分别为60.2小时和58.3小时 vs 88.5小时和93.6小时；P 结论：在 EoW 就诊的胆总管结石患儿的 LOS 和 TTDI 较长。当患儿进入 EF 通道时，这些结果会进一步放大。无论发病时间长短，以手术为先的方法都能减少手术次数、降低 TTDI 和缩短 LOS：证据等级：三级。
"Surgery First" vs. "Endoscopy First" for Pediatric Choledocholithiasis Presenting at the End of the Week - A CARES Working Group Study.
Background: Choledocholithiasis in children is commonly managed with an "endoscopy-first" (EF) strategy (endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC)). Because ERCP availability is often limited at the end of the week (EoW), we hypothesized that a "surgery-first" (SF) approach (LC with intraoperative cholangiogram (IOC) ± transcystic laparoscopic common bile exploration (LCBDE)) would decrease length of stay (LOS) and time to definitive intervention (TTDI).
Methods: A multicenter, retrospective cohort study was conducted on pediatric patients from 2018 to 2023 with suspected choledocholithiasis. Work week (WW) presentation was defined as admission between Monday to Thursday. TTDI was defined as time to LC or postoperative ERCP (if required).
Results: Among seven hospitals, there were 354 pediatric patients; 217 (61%) managed with SF (125 WW, 92 EoW) and 137 (39%) managed with EF (74 WW, 63 EoW). SF groups had a shorter LOS for both WW and EoW presentation (60.2 h and 58.3 h vs 88.5 h and 93.6 h respectively; p < 0.05). TTDI decreased in SF (26.4 h and 28.9 h vs 61.4 h and 72.8 h; p < 0.05). All EF patients underwent at least two anesthetics (preoperative ERCP followed by LC) while the majority (79%) of the SF group had only one procedure (LC + IOC ± LCBDE).
Conclusion: Children who present with choledocholithiasis at EoW have a longer LOS and TTDI. These findings are amplified when children enter an EF pathway. A surgery-first approach results in fewer procedures, decreased TTDI, and shorter LOS, regardless of the time of presentation.
期刊介绍：
The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
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