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The following is a summary of “Patient Safety and Radiation Exposure in Transcystic Laparoscopic Common Bile Duct Exploration: A CARES Working Group Multicenter Study,” published in the August 2024 issue of Pediatrics by Rauh et al.

The treatment of choledocholithiasis through laparoscopic cholecystectomy (LC) combined with intraoperative cholangiogram (IOC) and, when necessary, transcystic laparoscopic common bile duct exploration (LCBDE) has been shown to reduce the number of procedures and shorten the length of stay (LOS) compared to the traditional approach of preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by LC. However, the specifics of fluoroscopic time (FT) and radiation dose (RD) during LCBDE have yet to be extensively studied.

In this context, the Choledocholithiasis Alliance for Research, Education, and Surgery (CARES) Working Group conducted a retrospective multicenter study involving pediatric patients suspected of having choledocholithiasis who underwent IOC. The study aimed to evaluate the impact of LCBDE on FT and RD during the procedure. Researchers analyzed data from five centers, focusing on patient demographics, types of LCBDE procedures performed, and associated FT and RD during IOC and LCBDE. Statistical analyses were conducted using Microsoft Excel and R software.

The study included 157 patients, 79 undergoing IOC alone and 78 undergoing IOC combined with LCBDE. Successful wire access into the duodenum was achieved in 67 patients (86%), and in 64 patients (82%), duct clearance was successful. The median FT for all LCBDE cases was 3.3 minutes, with an interquartile range of 1.6 to 6.7 minutes, and the median RD was 59.8 mGy, with an interquartile range of 30.1 to 125.0 mGy. RD showed no significant difference between successful and unsuccessful duct clearance cases (66.7 mGy vs. 55.8 mGy; p=0.51).

In conclusion, while ERCP and LCBDE involve fluoroscopic radiation exposure, this study provides novel insights into FT and RD associated with LCBDE. These findings highlight the importance of fluoroscopy stewardship in minimizing radiation exposure, particularly in pediatric patients, underscoring the need to manage fluoroscopic procedures to enhance patient safety carefully.

Source: sciencedirect.com/science/article/abs/pii/S0022346824004883