Abstract
Laparoscopic common bile duct exploration (LCBDE) is underutilized in pediatric surgery despite its potential to reduce the need for endoscopic retrograde cholangiopancreatography (ERCP) and hospital length of stay. We aimed to characterize current LCBDE practice patterns among pediatric surgeons and identify barriers to broader adoption.
A 43-item survey assessing surgeon demographics, practice characteristics, LCBDE use, access to resources, and educational needs was distributed via REDCap to pediatric surgeons globally via the International Pediatric Endosurgery Group membership distribution list. Descriptive statistics were used to analyze responses.
A total of 132 pediatric surgeons responded (13.3 % response rate). All respondents had completed fellowship training, and 100 % identified as pediatric surgeons. Only 34.4 % currently perform LCBDE, and 91.1 % of those perform fewer than 10 cases per year. The transcystic approach was used in 86.7 % of cases. Preferred techniques included choledochoscopy (45.5 %) and balloon sphincteroplasty (27.3 %). Major barriers included lack of supplies, unfamiliarity with techniques, and low perceived utility. Only 16.4 % knew reimbursement rates for LCBDE. 75.7 % recognized that ERCP is associated with longer length of stay.
Despite its clinical benefits, LCBDE remains uncommon in pediatric surgery due to logistical, educational, and perceptual barriers. Targeted training and standardization of supplies may help increase adoption.