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Routine intraoperative cholangiography during laparoscopic cholecystectomy minimizes unnecessary endoscopic
J H Waldhausen1, D D Graham, D Tapper
1Division of Pediatric Surgery, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, WA 98105, USA.
Insights
Intraoperative cholangiography (IOC) is necessary in pediatric laparoscopic cholecystectomy (LC) as preoperative assessments may not accurately detect common bile duct (CBD) stones, which are common in children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Gallstone disease in children is increasingly diagnosed.
- Accurate assessment of the common bile duct (CBD) is crucial during cholecystectomy.
- The role of intraoperative cholangiography (IOC) in pediatric cases remains debated.
Purpose of the Study:
- To evaluate the necessity and diagnostic yield of IOC during pediatric laparoscopic cholecystectomy (LC).
- To assess the accuracy of preoperative diagnostic methods for detecting CBD stones in children.
- To determine the optimal management strategy for suspected choledocholithiasis in pediatric LC.
Main Methods:
- Retrospective review of 100 consecutive pediatric laparoscopic cholecystectomies.
- Analysis of IOC success rates, operating times, and complication rates.
- Comparison of preoperative diagnostic findings (ultrasound, laboratory, clinical) with intraoperative and postoperative findings of CBD stones.
Main Results:
- Common bile duct (CBD) stones were present in 18% of pediatric patients undergoing LC.
- Preoperative assessments were unreliable in predicting the presence or absence of CBD stones in 8% of cases.
- IOC was successful in identifying CBD stones and guided management, avoiding unnecessary procedures in some cases.
Conclusions:
- CBD stones are a significant finding in pediatric gallstone disease.
- Intraoperative cholangiography (IOC) is a valuable tool for accurate diagnosis of CBD stones during pediatric LC.
- Routine IOC should be considered before resorting to more invasive procedures like ERCP, unless CBD stones are clearly visualized preoperatively.
Purpose:
The aim of this study was to determine the necessity for intraoperative cholangiography (IOC) during pediatric laparoscopic cholecystectomy (LC).
Methods:
A retrospective review of 100 consecutive patients undergoing LC was conducted.
Results:
Ninety-eight children underwent successful LC. The average age was 11.3 years. IOC was successful in 55 of 63 studies. Operating time for patients with IOC averaged 91 minutes, and without IOC, 67 minutes. Twenty children had preoperative ultrasound, laboratory, or clinical evidence of common bile duct (CBD) stones. Fifteen of these 20 children actually had CBD stones. Three additional children who lacked any ultrasound, clinical, or laboratory evidence of choledocholithiasis had unsuspected CBD stones. Eight children, therefore, had ultrasound, clinical, or laboratory findings not predictive of the actual state of the CBD. Sixteen children underwent endoscopic retrograde cholangiopancreatography (ERCP), 9 preoperatively and 7 postoperatively. Four preoperative ERCP studies showed no CBD stones. There were no complications from performing IOC.
Conclusions:
(1) CBD stones are common in children with gallstones, (18 of 100 patients). (2) Preoperative studies and clinical findings may not predict accurately the presence or absence of CBD stones. (3) IOC should be routinely performed in children before the use of ERCP to avoid unnecessary ERCP unless CBD stones are specifically visualized by ultrasound scan. J Pediatr Surg 36:881-884.