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Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Paediatric cholecystectomy: Shifting goalposts in the laparoscopic era
1Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Dyke Road, Brighton, BN1 3JN, United Kingdom.
Insights
Laparoscopic cholecystectomy is effective for symptomatic pediatric gallstones. While indications are expanding, further research is needed on asymptomatic cases and biliary dyskinesia to establish best practices.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy is the standard for symptomatic pediatric gallstones.
- Its use in asymptomatic gallstones and biliary dyskinesia remains debated.
- This study reviews outcomes from two UK pediatric centers.
Purpose of the Study:
- To evaluate the indications and outcomes of laparoscopic cholecystectomy in children.
- To assess the role of advanced imaging in pediatric biliary surgery.
- To contribute to the understanding of gallstone disease management in pediatric populations.
Main Methods:
- Retrospective analysis of 27 laparoscopic cholecystectomies performed between 1996 and 2005.
- Data collected from prospectively held databases at two UK pediatric surgical centers.
- Inclusion of patients with symptomatic gallstones, hemolytic disease, pancreatitis, trauma, and asymptomatic stones.
Main Results:
- Symptomatic idiopathic cholelithiasis was the primary indication (14 cases).
- Other indications included hemolytic disease, pancreatitis, trauma, and asymptomatic calcific stones (7 cases).
- Mean operative time was 105 minutes, with a median postoperative stay of one day; histology revealed chronic cholecystitis in most cases.
Conclusions:
- Laparoscopic cholecystectomy indications have broadened in pediatric surgery.
- Magnetic resonance cholangiopancreatography (MRCP) is valuable for excluding common bile duct stones.
- A consensus supports cholecystectomy for calcific, non-resolving pediatric gallstones, though the natural history of asymptomatic stones requires further study.
Background:
Laparoscopic cholecystectomy is the treatment of choice in symptomatic paediatric cholelithiasis. However, controversy exists about its role in asymptomatic cholelithiasis and biliary dyskinesia. We have reviewed the experiences of two UK paediatric centres with laparoscopic cholecystectomy over an 8.5 year period and critically evaluated the indications and outcomes of surgery.
Methods:
Patients who underwent laparoscopic cholecystectomy by a single surgeon at the Royal Aberdeen and Royal Alexandra Hospitals between May 1996 to August 2003 and September 2003 to December 2005, respectively, were studied. Information was extracted from prospectively held databases and analysed.
Results:
A total of 27 cholecystectomies were performed during the period of study. The mean age of patients was 11.7 years with a female preponderance. Symptomatic idiopathic cholelithiasis was the main indication for surgery (14). Cholecystectomy was also performed for haemolytic disease (3), acute recurrent pancreatitis of unknown cause (2), gallbladder trauma (1), and for asymptomatic calcific non-resolving stones (7). All patients were investigated with ultrasound scans with four patients undergoing magnetic resonance cholangiopancreatography (MRCP) for suspected common bile duct (CBD) stones. A standard four-port approach was used with the gallbladder extracted through the umbilical port. The mean operative time in the latter 13 cases was 105 minutes with a median postoperative stay of one day for the whole series. Histology revealed chronic cholecystitis in all but three cases. All patients were discharged after a six-month follow-up period.
Conclusions:
The advent of laparoscopy has resulted in an expansion of the traditional indications for cholecystectomy. MRCP is a useful investigation in selected children to exclude choledocholithiasis and avoid intraoperative cholangiography. There appears to be no clear correlation between histology and presenting symptoms. The natural history of asymptomatic gallstones in children is not known although a consensus is emerging to support cholecystectomy for all calcific non-resolving gallstones.
