In this session from the 12th Annual Update Course in Pediatric Surgery, Drs. David Vitale, Luke Neff, and Jeffrey Ponsky explore strategies for preventing gallstone pancreatitis in pediatric patients with biliary stones. This session is classified as a Green Circle (established practice).Key Highlights:Managing complex cases: When to use conservative management with antibiotics for neutropenic, thrombocytopenic patients.Gallstone pancreatitis: How to differentiate management from typical choledocholithiasis cases.Timing of cholecystectomy: Why surgery should be based on clinical improvement rather than complete biochemical normalization.ERCP and IOC coordination: Determining when early ERCP is necessary and incorporating intraoperative cholangiograms for safe stone clearance.Clinical judgment matters: How local resources and patient-specific factors shape decision-making.This session emphasizes balancing early intervention with patient safety and tailoring care to individual circumstances.

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