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[Preoperatory sonography efficiency in paediatric patients with cholelithiasis undergoing laparoscopic
C Riñón1, L de Mingo, M J Cortés
1Servicio de Cirugía General Pediátrica, Hospital Universitario Niño Jesús, Madrid. cristinarignon@hotmail.com
Insights
Preoperative ultrasound is a safe and effective method for diagnosing pediatric biliary lithiasis before laparoscopic surgery. This approach avoids the need for intraoperative cholangiography, reducing potential complications in children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Biliary lithiasis is uncommon in pediatric patients but appears to be increasing.
- Management of cholelithiasis in children undergoing laparoscopic cholecystectomy remains debated.
- Intraoperative cholangiography can be challenging and risky in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and safety of preoperative sonography for biliary lithiasis in pediatric patients.
- To establish preoperative ultrasound as a preferred diagnostic tool over intraoperative cholangiography.
- To assess the diagnostic yield and complication rates associated with preoperative biliary tree imaging.
Main Methods:
- Retrospective study of 42 pediatric patients (18 months–17 years) with symptomatic biliary lithiasis.
- All patients underwent abdominal sonography 24–48 hours prior to laparoscopic cholecystectomy.
- Data collected included patient demographics, clinical presentation, and imaging findings.
Main Results:
- Four children were diagnosed with biliary duct lithiasis (2 choledocholithiasis, 2 cystic duct stones).
- One cystic duct stone required intraoperative extraction; others resolved spontaneously.
- One patient had postoperative common bile duct dilatation that resolved spontaneously, with no complications reported.
Conclusions:
- Preoperative sonography is a safe and effective first-choice method for diagnosing and monitoring pediatric biliary lithiasis.
- It offers a reliable alternative to intraoperative cholangiography, which poses technical difficulties and risks in children.
- This imaging technique facilitates appropriate management decisions for pediatric patients undergoing laparoscopic cholecystectomy.
Introduction:
Biliary lithiasis is not much frequent in paediatric patients. The manegement of cholelithiasis in patients undergoing laparoscopic cholecystectomy is still controversial. We propose the preoperatory echographic study of the biliary tree 24-48 h before surgery, as the first choice, instead of the intraoperatory cholangiography.
Material And Methods:
We made a retrospective study of 42 patients undergoing laparoscopic cholecystectomy due to symptomatic biliary lithiasis during the last 15 years, with ages between 18 months and 17-years-old (mean age 9,6-years-old) and weight between 11 and 70 kg (mean weight 42 kg) at the moment of surgery. Six of them had haematological illnesses, 17 came to the hospital because of acute abdominal pain, 10 had been studied because of recurrent abdominal pain and 9 had casual diagnoses. Abdominal sonography was performed in all patients 24-48 hours before surgery.
Results:
Four children were diagnosed of biliary duct lithiasis: two choledocolithiasis and two stones in the cystic duct. One of the cystic stones was extracted in the operating room and the rest resolved spontaneously. One patient presented dilatation of choledocal duct after surgery, without any stones' evidence. Also this patient resolved spontaneously. We had no complications.
Conclusions:
Biliary lithiasis is not frequent in children, even if it seems to be increasing. A few of these patients will suffer of choledocolithiasis. The intraoperatory exploration of the biliary tree during laparoscopic surgery is technically difficult due the small size of paediatric patients. Cholangiography is not always successful and can produce some important complications as pancreatitis. Preoperative sonography 24-48 hours before surgery is a safe and efficient method for the diagnosis and follow-up of paediatric patients with biliary lithiasis undergoing laparoscopic cholecystectomy. It is safe enough to be performed without intraoperatory cholangiography.