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Seminars in Pediatric Surgery最新文献

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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 ,&nbsp;Jessica K. Sims ,&nbsp;Jordan Busing ,&nbsp;Sari Acra ,&nbsp;Anthony Gamboa ,&nbsp;J. Andres Martinez ,&nbsp;Rekha Krishnasarma ,&nbsp;Jessica L. Rauh ,&nbsp;Lucas P. Neff ,&nbsp;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.
{"title":"Preoperative evaluation of biliary disease in children","authors":"Joseph J. Lee ,&nbsp;Romeo C. Ignacio Jr.","doi":"10.1016/j.sempedsurg.2025.151494","DOIUrl":"10.1016/j.sempedsurg.2025.151494","url":null,"abstract":"<div><div>Pediatric biliary disease exhibits a wide range of manifestations depending on age, demographics, and clinical presentation, often lacking a standardized diagnostic pathway for many medical and surgical conditions. This article provides a systematic approach to the preoperative evaluation of pediatric patients, starting with clinical assessment and progressing to adjunct laboratory tests and imaging studies. Covering the spectrum from the neonatal period to young adulthood, we review current literature and guidelines to highlight the essential components of an effective preoperative workup for children with suspected biliary disease.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151494"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579512","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
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 ,&nbsp;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
{"title":"Surgical management of uncomplicated biliary stone disease in children","authors":"Jessica K. Sims ,&nbsp;Meredith A. Achey ,&nbsp;Irving J. Zamora","doi":"10.1016/j.sempedsurg.2025.151495","DOIUrl":"10.1016/j.sempedsurg.2025.151495","url":null,"abstract":"<div><div>Biliary stone disease is increasingly prevalent in the pediatric population, driven in part by the rising rates of obesity. Estimates place the prevalence between 1.9 % and 4 %, with a concomitant increase in pediatric cholecystectomies. Whereas hemolytic anemias were historically the leading indication, non-hemolytic conditions are now frequently encountered. Pediatric surgeons must be adept at managing uncomplicated biliary stone disease across various age groups. This review outlines the surgical management of pediatric biliary stone disease, with emphasis on recent advances in minimally invasive techniques.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151495"},"PeriodicalIF":1.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569856","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
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
{"title":"Endoscopic treatments for complicated biliary disease in children","authors":"Nicholas Norris ,&nbsp;David S. Vitale","doi":"10.1016/j.sempedsurg.2025.151500","DOIUrl":"10.1016/j.sempedsurg.2025.151500","url":null,"abstract":"<div><div>Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are frequently employed in the management of biliary disease. With growing utilization in the pediatric population mirroring the rise in gallstone-related disease, it is important to have improved access to pediatric-specific advanced endoscopic care. Multi-center collaborations have now provided more robust data on the safety and efficacy of ERCP in pediatric patients. EUS remains primarily diagnostic in evaluating biliary pathology but is slowly emerging as a therapeutic modality following the adult experience with biliary drainage procedures. Access to pediatric-specific endoscopic equipment remains a challenge in this population. In this review, we provide an overview of endoscopic treatment options for biliary disease in children, discussing the most relevant recent literature while providing approaches to some of the most encountered complex biliary diseases.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151500"},"PeriodicalIF":1.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579511","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
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 ,&nbsp;Carmelle Romain ,&nbsp;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 ,&nbsp;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
{"title":"Biliary dyskinesia in the pediatric population","authors":"Sophia MV Schermerhorn ,&nbsp;Afif N. Kulaylat ,&nbsp;Donald J. Lucas","doi":"10.1016/j.sempedsurg.2025.151503","DOIUrl":"10.1016/j.sempedsurg.2025.151503","url":null,"abstract":"<div><div>Biliary dyskinesia (BD) is a functional gallbladder disorder increasingly diagnosed in pediatric patients and a leading indication for laparoscopic cholecystectomy (LC). The pathophysiology remains unclear despite its prevalence, with gallbladder dysmotility and inflammation implicated. Diagnostic challenges arise from a lack of validated pediatric criteria and inconsistent hepatobiliary iminodiacetic acid (HIDA) scan technique and interpretation. LC is effective for symptom resolution with low complication rates, but medical management, including proton pump inhibitors, demonstrates variable success. This review highlights the need for prospective studies to refine diagnostic criteria, identify predictors of treatment success, and compare treatment strategies to improve outcomes for children with BD.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"34 ","pages":"Article 151503"},"PeriodicalIF":1.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563390","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
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
{"title":"Management of gallstone pancreatitis in children","authors":"Arianna Kahler-Quesada ,&nbsp;Insiyah Campwala ,&nbsp;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}
引用次数: 0
Endoscopic and surgical approaches in the management of pediatric gallstone disease: A review of associated complications 内镜和手术方法在儿童胆结石疾病的管理：相关并发症的回顾
IF 1.4 3区 医学
Seminars in Pediatric Surgery Pub Date : 2025-06-29 DOI: 10.1016/j.sempedsurg.2025.151497
Micaela K. Gomez , Maggie E. Bosley
{"title":"Endoscopic and surgical approaches in the management of pediatric gallstone disease: A review of associated complications","authors":"Micaela K. Gomez ,&nbsp;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}
引用次数: 0
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