MULTIDISCIPLINARY APPROACH TO THE TREATMENT OF PEDIATRIC PANCREATICOBILIARY DISORDERS

A multidisciplinary approach using traditional open surgery, endoscopi c retrograde cholangiopancreatography (ERCP) and laparoscopic surgery has revolutionized the care of the adult with pancreaticobiliary disea se. This study focuses on a similar collaborative effort to diagnose a nd treat children with pancreaticobiliary disorders. Charts of all pat ients treated on the pediatric surgery service between June 1990 and M ay 1995, who also underwent ERCP. were abstracted for disease process, presenting symptoms, laboratory evaluation, surgical or endoscopic pr ocedures, and eventual outcome. Twenty-six children were identified, r anging from 6 months to 19 years of age. Pancreaticobiliary disorders included pancreas divisum (n = 1), choledochal cyst (n = 4), pancreati cobiliary trauma (n = 4), cholelithiasis and choledocholithiasis (n = 17). The pancreaticobiliary tree was successfully visualized by ERCP i n 25 of 26 (96%) patients. Fifteen of these patients also underwent at tempted therapeutic endoscopic procedures, with 13 (87%) performed suc cessfully. Three patients with choledochal cyst had stents placed preo peratively far cholangitis, all of wham have undergone successful chol edochal cyst excision. Two trauma patients underwent attempted stentin g of a bile leak and bile duct stricture, respectively, both of which were unsuccessful, necessitating surgical correction. Seventeen patien ts with cholelithiasis underwent ERCP to rule out choledocholithiasis. Ten patients were found to have common duct stones, and all stones we re endoscopically extracted, including those in a 6-month-old child. O verall survival rate was 96% (25 of 26), with the one death occurring in a trauma patient unrelated to his pancreaticobiliary disorder. A mu ltidisciplinary approach using traditional open surgery, ERCP and lapa roscopic surgery can successfully treat even young children with pancr eaticobiliary disorders. In experienced hands, diagnostic ERCP and the rapeutic endoscopic intervention can be performed successfully in most pediatric patients, greatly simplifying the surgical management of th ese potentially complex problems. Copyright (C) 1997 by M.B. Saunders Company.