# Pediatric cholecystectomy practices and training: an International Multicenter Survey by the European Union of Medical Specialists (UEMS) Section of Paediatric Surgery

## TL;DR

This study surveyed European pediatric surgery centers to understand how they perform cholecystectomy in children, revealing significant variation in practices and training.

## Contribution

The study provides the first international survey on pediatric biliary cholecystectomy practices and training within the UEMS.

## Key findings

- Most centers lack formal pediatric-specific guidelines for cholecystectomy.
- Trainee-led operations are limited, with only 22.5% of cases performed by trainees.
- Laparoscopic cholecystectomy is dominant, with low complication rates reported.

## Abstract

Pediatric cholecystitis and cholelithiasis management is heterogeneous. We surveyed European centers to map current practices, training exposure, and outcomes of pediatric biliary cholecystectomy.

A 24-item cross-sectional international survey was developed by the European Union of Medical Specialists (UEMS) Section of Paediatric Surgery and distributed to centers in 31 UEMS member states. Items covered institutional resources, indications and timing, surgical approach and adjuncts (ERCP, ICG), training exposure, and center-level outcomes; results are reported as n (%), median (IQR). Outcomes were reported at the center level and were self-reported by participating institutions.

Thirty-two centers from 23/31 states responded (74.2%). Pediatric surgeons were primary operators in 84% (shared with adult surgeons in 16%); ERCP access was 66%. Trainee operator share was 22.5% (IQR 5–50) and simulator access 56%. ICG cholangiography was routine in 12.5% and selective in 31%. Acute calculous cholecystitis: 6% always index-admission and 59.4% interval (29–41 days) cholecystectomy; post-ERCP choledocholithiasis: 16% always index-admission cholecystectomy. In 2023, 185 cases were reported: 98.9% laparoscopic with 1.6% conversion; median age 14 years (IQR 12.25–15), operative time 90 min (IQR 60–110), length of stay 2 days (IQR 1–2); 10 complications (5.4%).

Substantial heterogeneity persists in both care pathways and training exposure; most centers lack formal pediatric-specific guidelines, and trainee-led operating remains limited, supporting the need for evidence-based protocols and structured training pathways.

The online version contains supplementary material available at 10.1007/s00383-026-06357-y.