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Laparoscopic techniques for safe and successful removal of common bile duct stones in pediatric patients
Briana J Lau1, Roman M Sydorak, Donald B Shaul
1Department of Surgery, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California.
Insights
Laparoscopic common bile duct exploration is a safe and feasible technique for pediatric patients with choledocholithiasis. Various instruments allow for tailored stone extraction, achieving successful outcomes without complications.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Minimally invasive surgery
Background:
- Choledocholithiasis (bile duct stones) is rare in children.
- Established techniques for pediatric common bile duct stone extraction are limited.
Purpose of the Study:
- To describe safe and applicable techniques for pediatric common bile duct exploration.
- To evaluate the feasibility of laparoscopic approaches in pediatric patients.
Main Methods:
- Retrospective review of prospectively maintained data (April 2008–March 2012).
- Analysis of patients undergoing laparoscopic common bile duct exploration by two pediatric surgeons at two tertiary centers.
Main Results:
- Seven of eight pediatric patients with common bile duct stones successfully underwent laparoscopic exploration and stone clearance.
- No complications or conversions to open surgery were reported.
- Various stone extraction methods were utilized, including saline flush, balloon catheters, and stone extractors.
Conclusions:
- Laparoscopic common bile duct exploration is a viable option for pediatric patients.
- Readily available operating room instruments can be used for pediatric stone extraction.
- Techniques can be individualized based on patient anatomy and stone characteristics.
Background/Purpose:
Choledocholithiasis is uncommon in the pediatric population. Techniques for common bile duct stone extraction are still not well established. This article aims to describe safe and applicable techniques for pediatric common bile duct exploration.
Materials And Methods:
This was a retrospective review of a prospectively maintained database of two pediatric surgeons for patients undergoing laparoscopic common bile duct exploration at two tertiary-care centers from April 2008 to March 2012.
Results:
For 39 patients under 15 years of age undergoing laparoscopic cholecystectomy, 10 cholangiograms were performed, and 8 were found to have filling defects. Seven patients underwent successful laparoscopic common bile duct exploration with documentation of stone clearance, and 1 patient was sent for postoperative endoscopic retrograde cholangiopancreatography with stone extraction. Eleven patients had cholecystectomy performed by single-incision laparoscopic surgery, but none of these had cholangiograms or common bile duct explorations. Various methods of stone clearance were used, including the use of saline flush, balloon catheters, nitinol stone extractors, and the aide of glucagon. Depending on patient size, a choledochosope or a ureteroscope was used. There were no complications and no conversions to open surgery.
Conclusions:
Laparoscopic common bile duct exploration is feasible in the pediatric population, using many of the instruments readily available in the standard operating room. With an armamentarium of tools and techniques, the method of stone extraction can be tailored to the patient and situation.
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