Seminars in Pediatric Surgery最新文献

fm i -- Contents fm i -目录

IF 1.4 3区医学

Seminars in Pediatric Surgery Pub Date : 2025-07-22 DOI: 10.1053/S1055-8586(25)00038-1

引用次数: 0

Shifting the pediatric choledocholithiasis paradigm: Development of a surgery-first clinical practice guideline at a tertiary children’s hospital 转变儿童胆总管结石的范例：在三级儿童医院制定手术优先的临床实践指南

IF 1.4 3区医学

Seminars in Pediatric Surgery Pub Date : 2025-07-01 DOI: 10.1016/j.sempedsurg.2025.151496

Meredith A. Achey , Jessica K. Sims , Jordan Busing , Sari Acra , Anthony Gamboa , J. Andres Martinez , Rekha Krishnasarma , Jessica L. Rauh , Lucas P. Neff , Irving J. Zamora

{"title":"Shifting the pediatric choledocholithiasis paradigm: Development of a surgery-first clinical practice guideline at a tertiary children’s hospital","authors":"Meredith A. Achey , Jessica K. Sims , Jordan Busing , Sari Acra , Anthony Gamboa , J. Andres Martinez , Rekha Krishnasarma , Jessica L. Rauh , Lucas P. Neff , Irving J. Zamora","doi":"10.1016/j.sempedsurg.2025.151496","DOIUrl":"10.1016/j.sempedsurg.2025.151496","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric choledocholithiasis has traditionally been managed with a two-stage endoscopy-first (EF) approach involving ERCP followed by cholecystectomy. This strategy increases hospital length of stay (LOS), procedural complexity, and exposure to anesthesia. A growing body of evidence supports a surgery-first (SF) paradigm.</div></div><div><h3>Methods</h3><div>A multidisciplinary team at a tertiary pediatric center developed a clinical practice guideline (CPG) in 2023 using the Pediatric DUCT score to risk-stratify patients and prioritize early surgical consultation. The guideline was informally piloted in April 2024 and formally implemented in January 2025.</div></div><div><h3>Results</h3><div>The CPG emphasizes early referral to pediatric surgery and upfront laparoscopic cholecystectomy with intraoperative cholangiography (IOC) and common bile duct exploration (LCBDE) when indicated. Preliminary experience has demonstrated reduced reliance on magnetic resonance cholangiopancreatogphy (MRCP) and increased adoption of single-stage definitive management.</div></div><div><h3>Conclusions</h3><div>A surgery-first approach for choledocholithiasis is safe, feasible, and effective in pediatric patients. Institutional implementation of structured clinical practice guidelines based on validated criteria, enables high-value, streamlined care of children with biliary disease.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151496"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579364","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}

引用次数: 0

Preoperative evaluation of biliary disease in children 儿童胆道疾病的术前评价

IF 1.4 3区医学

Seminars in Pediatric Surgery Pub Date : 2025-07-01 DOI: 10.1016/j.sempedsurg.2025.151494

Joseph J. Lee , Romeo C. Ignacio Jr.

引用次数: 0

Non-congenital biliary disease in infants 婴儿非先天性胆道疾病

IF 1.4 3区医学

Seminars in Pediatric Surgery Pub Date : 2025-06-30 DOI: 10.1016/j.sempedsurg.2025.151504

Alison Lehane , Hanna Alemayehu

{"title":"Non-congenital biliary disease in infants","authors":"Alison Lehane , Hanna Alemayehu","doi":"10.1016/j.sempedsurg.2025.151504","DOIUrl":"10.1016/j.sempedsurg.2025.151504","url":null,"abstract":"<div><div>Non-congenital biliary diseases in infants, such as inspissated bile syndrome, hemolysis-related cholelithiasis, and recurrent pyogenic cholangitis, can lead to significant morbidity due to biliary obstruction and hepatic dysfunction. Diagnosis typically involves clinical evaluation, liver function testing, and imaging, with ultrasound as the first-line modality. Management depends on the underlying etiology and severity, with many cases resolving through supportive care, removal of offending agents, and bile acid therapy. Surgical intervention is indicated for persistent or complicated cases. While endoscopic retrograde cholangiopancreatography (ERCP) is often limited in neonates due to technical constraints, laparoscopic common bile duct exploration (LCBDE) has emerged as a viable alternative, offering ductal clearance through transcystic or direct approaches. Techniques such as power flushing, balloon sphincteroplasty, and stone retrieval devices have shown success in pediatric populations. Long-term follow-up is essential to monitor for recurrence, particularly in patients with ongoing hemolytic disorders. Continued research and innovation are needed to optimize diagnostic and therapeutic strategies for these complex conditions in infants.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151504"},"PeriodicalIF":1.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557494","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}

引用次数: 0

Surgical management of uncomplicated biliary stone disease in children 儿童无并发症胆结石疾病的外科治疗

IF 1.4 3区医学

Seminars in Pediatric Surgery Pub Date : 2025-06-30 DOI: 10.1016/j.sempedsurg.2025.151495

Jessica K. Sims , Meredith A. Achey , Irving J. Zamora

引用次数: 0

Endoscopic treatments for complicated biliary disease in children 儿童复杂胆道疾病的内镜治疗

IF 1.4 3区医学

Seminars in Pediatric Surgery Pub Date : 2025-06-29 DOI: 10.1016/j.sempedsurg.2025.151500

Nicholas Norris , David S. Vitale

引用次数: 0

Advances in intraoperative imaging technologies for complex biliary disease 复杂胆道疾病术中影像技术的进展

IF 1.4 3区医学

Seminars in Pediatric Surgery Pub Date : 2025-06-29 DOI: 10.1016/j.sempedsurg.2025.151498

Dena G. Shehata , Carmelle Romain , Bethany J. Slater

{"title":"Advances in intraoperative imaging technologies for complex biliary disease","authors":"Dena G. Shehata , Carmelle Romain , Bethany J. Slater","doi":"10.1016/j.sempedsurg.2025.151498","DOIUrl":"10.1016/j.sempedsurg.2025.151498","url":null,"abstract":"<div><div>Intraoperative imaging has enhanced the precision of biliary surgery in pediatric patients by improving visualization and reducing complications. This review examines intraoperative cholangiography (IOC), fluorescent cholangiography (FC) with indocyanine green (ICG), laparoscopic ultrasound (LUS), and endoscopic retrograde cholangiopancreatography (ERCP). IOC remains the gold standard for identifying biliary anomalies but raises concerns about radiation exposure and operative time. FC with ICG provides a radiation-free alternative with improved visualization and shorter procedures, though its effectiveness depends on equipment availability. LUS enables real-time, radiation-free assessment of biliary anatomy but requires significant operator expertise. ERCP serves both diagnostic and therapeutic roles but carries risks such as pancreatitis and demands specialized training. While each modality has advantages and limitations, their combined use enhances intraoperative decision-making. Emerging technologies, including artificial intelligence and augmented reality, may further improve outcomes.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151498"},"PeriodicalIF":1.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571189","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}

引用次数: 0

Techniques of common bile duct exploration in pediatric surgery 小儿外科胆总管探查技术

IF 1.4 3区医学

Seminars in Pediatric Surgery Pub Date : 2025-06-29 DOI: 10.1016/j.sempedsurg.2025.151499

Heather Ots , Anthony Y. Tsai

{"title":"Techniques of common bile duct exploration in pediatric surgery","authors":"Heather Ots , Anthony Y. Tsai","doi":"10.1016/j.sempedsurg.2025.151499","DOIUrl":"10.1016/j.sempedsurg.2025.151499","url":null,"abstract":"<div><div>With the rising of incidents in pediatric cholelithiasis, pediatric surgeons are increasingly encountering patients with choledocholithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) has long been considered the gold standard for diagnosis and treatment, offering rapid relief of biliary obstruction— sometimes without general anesthesia. However, ERCP is not without risks and in the pediatric population is often limited by institutional availability, occasionally requiring interfacility transfer and escalating healthcare costs. Recently, transcystic laparoscopic common bile duct exploration (LCBDE) has emerged as a safe and effective alternative in pediatric patients, despite earlier concerns regarding anatomical feasibility. Once cystic duct access is achieved, simple techniques such as saline flushing may suffice for duct clearance while more advanced maneuvers—such as sphincter balloon dilation, stone retrieval with wire baskets, and direct choledochoscopy—can be performed when needed. This manuscript provides a practical guide for pediatric surgeons performing LCBDE and outlines key technical strategies to enhance procedural success.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151499"},"PeriodicalIF":1.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579513","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}

引用次数: 0

Biliary dyskinesia in the pediatric population 小儿人群中的胆道运动障碍

IF 1.4 3区医学

Seminars in Pediatric Surgery Pub Date : 2025-06-29 DOI: 10.1016/j.sempedsurg.2025.151503

Sophia MV Schermerhorn , Afif N. Kulaylat , Donald J. Lucas

引用次数: 0

Management of gallstone pancreatitis in children 儿童胆石性胰腺炎的治疗

IF 1.4 3区医学

Seminars in Pediatric Surgery Pub Date : 2025-06-29 DOI: 10.1016/j.sempedsurg.2025.151502

Arianna Kahler-Quesada , Insiyah Campwala , Stefan Scholz

引用次数: 0