Related Experiment Video
Updated: Jul 13, 2026
Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture
Published on: November 25, 2025
Is perioperative cholangiography necessary in children undergoing elective laparoscopic cholecystectomy?
G Mattioli1, A Pini-Prato, M Castagnetti
1Department of Paediatric Surgery, G. Gaslini Research Institute, University of Genoa, Genoa, Italy. girolamomattioli@ospedale-gaslini.ge.it
Insights
Routine preoperative biliary imaging is unnecessary for children undergoing laparoscopic cholecystectomy (LC) if they have no clinical or biochemical signs of common bile duct (CBD) stones. This avoids unnecessary procedures and associated risks in pediatric patients.
Area of Science:
- Pediatric Surgery
- Biliary Tract Surgery
- Diagnostic Imaging
Background:
- The necessity of preoperative or intraoperative imaging of the biliary tree before laparoscopic cholecystectomy (LC) in children is debated.
- This study addresses the risk of bile duct injury or common bile duct (CBD) stones in pediatric patients not undergoing peri-operative cholangiography.
Purpose of the Study:
- To prospectively assess the risk of developing symptoms related to bile duct injury or CBD stones after LC in children who do not receive peri-operative cholangiography.
Main Methods:
- Prospective study of pediatric patients (
- Peri-operative cholangiography was only performed if CBD stones were suspected based on clinical, biochemical, or ultrasound findings.
- Patients were followed postoperatively for symptoms or signs of bile duct injury or CBD stones.
Main Results:
- Twenty-six pediatric patients underwent elective LC without complications.
- No patients developed early symptoms of stone migration or signs of CBD stones postoperatively.
- Ultrasound at 1 month and median follow-up of 25 months showed no biliary dilatation or CBD stones.
Conclusions:
- Pre- or intra-operative cholangiography is not required for elective LC in pediatric patients with normal clinical examination, liver biochemistry, and ultrasound findings.
- Selective use of cholangiography based on clinical suspicion is sufficient for pediatric LC.
Background:
The necessity of carrying out pre- or intra-operative imaging of the biliary tree to rule out a possible anatomical abnormality or the presence of common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC) is debated. We prospectively assessed the risk of developing symptoms related to bile duct injury or CBD stones after LC in children not receiving peri-operative cholangiography.
Materials And Methods:
All patients
Results:
Twenty-six patients fulfilled the inclusion criteria. The median age at elective LC was 9.8 (4.1 - 14.3) years. Surgery was uneventful in all patients. All patients were discharged on postoperative day 1. None developed early symptoms of stone migration. USS performed 1 month after surgery did not show dilatation of the biliary system or stones in the CBD in any patient and no patient developed symptoms related to CBD stones after a median postoperative follow-up of 25 (6 - 37) months.
Conclusions:
Patients scheduled for elective LC presenting with unremarkable clinical examination, normal liver biochemistry and serum amylase levels, and without dilatation of the biliary tree on ultrasound scan do not need pre- or intra-operative cholangiography.
