2025 Pediatric Surgery Update Course - Updates in Lap Chole and Cholecystitis Management

Index cholecystectomy performed during initial admission reduces readmission rate from 22% to 2-3% according to a 2024 Surgical Endoscopy paper

Index admission cholecystectomy significantly shortens length of stay from 22 days to 6 days

Adult Infectious Disease Society guidelines recommend against antibiotic prophylaxis for cholecystectomy citing concerns about antimicrobial resistance, according to a 2025 JAMA article

A two-center study of over 2000 children found more than 90% received antibiotic prophylaxis for cholecystectomy

Prophylaxis antibiotics were associated with a 72% reduction in the odds of surgical site infection in pediatric cholecystectomy

The number needed to treat with prophylaxis to prevent a single surgical site infection was calculated around 35

There is no additional benefit from using extended spectrum compared with narrow spectrum antibiotics like cefazolin for cholecystectomy prophylaxis

A French hospital successfully implemented ERAS protocol for pediatric laparoscopic cholecystectomy in 90% of patients over a five-year period

There were no postoperative complications or readmissions during 30-day observation in the French ERAS cohort

At medium-long term follow-up to 55 months, there were no health issues associated with same-day discharge after pediatric cholecystectomy

A 2024 systematic review from Pediatric Surgery International reviewed over 19,000 pediatric laparoscopic cholecystectomies

For simple cholecystitis, higher operative volume is the key determinant for favorable outcomes, with high volume more common in adult surgeons

High volume surgeons showed statistically significant reduction in postoperative complications and 30-day readmission rates

The systematic review recommends pediatric surgeon participation for more complex children with special needs such as hemolytic disorders