Related Experiment Video
Updated: Aug 23, 2025
Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
The Laparoscopic Cholecystectomy and Common Bile Duct Exploration: A Single-Step Treatment of Pediatric
Zenon Pogorelić1,2, Marko Lovrić2, Miro Jukić1,2
1Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia.
Insights
Laparoscopic common bile duct exploration (LCBDE) is a safe and effective treatment for pediatric choledocholithiasis, offering a shorter hospital stay than laparoscopic cholecystectomy with endoscopic retrograde cholangiopancreatography (LC+ERCP). This single-procedure approach avoids papillotomy and fluoroscopy.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Procedures
Background:
- Complicated biliary tract diseases are increasingly diagnosed in children.
- Laparoscopic common bile duct exploration (LCBDE) is gaining popularity for treating pediatric choledocholithiasis.
- This study compares LCBDE outcomes with endoscopic retrograde cholangiopancreatography (ERCP).
Purpose of the Study:
- To investigate the outcomes of LCBDE in pediatric patients.
- To compare the efficacy and safety of LCBDE with LC + ERCP for choledocholithiasis.
- To evaluate complications, recurrence, and reoperation rates.
Main Methods:
- A retrospective study of 84 children undergoing laparoscopic cholecystectomy from 2000-2022.
- Comparison between 14 children treated with LCBDE and 6 children treated with LC + ERCP.
- Primary endpoints: treatment success, complications, recurrence, reoperation. Secondary endpoints: operative time, hospital stay.
Main Results:
- LCBDE successfully removed stones in 71.4% of cases, with fragmentation in 28.6%.
- LCBDE group had a significantly shorter hospital stay (2 vs. 4 days, p=0.011).
- No complications were observed in the LCBDE group versus two in the ERCP group (p=0.078).
Conclusions:
- LCBDE is a safe and feasible approach for pediatric choledocholithiasis.
- LCBDE allows for single-procedure treatment of choledocholithiasis and cholelithiasis without papillotomy or fluoroscopy.
- LCBDE offers a shorter hospital stay compared to LC + ERCP with a low incidence of complications.
Background:
In recent years, complicated biliary tract diseases are increasingly diagnosed in children. Laparoscopic exploration of the common bile duct (LCBDE) followed by laparoscopic cholecystectomy has gained popularity in children. The aim of this study was to investigate the outcomes of LCBDE in children and compare them with the treatment outcomes of previously used endoscopic retrograde cholangiopancreatography (ERCP).
Methods:
From January 2000 to January 2022, a total of 84 children (78.5% female) underwent laparoscopic cholecystectomy with a median follow-up of 11.4 (IQR 8, 14) years. Of these, 6 children underwent laparoscopic cholecystectomy (LC) + ERCP and 14 children underwent LCBDE for choledochiothiasis. The primary end point of the study was the success of treatment in terms of the incidence of complications, recurrence rate, and rate of reoperation. Secondary endpoints were stone characteristics, presenting symptoms, duration of surgery, and length of hospital stay.
Results:
The majority of patients were female in both groups (83.5% vs. 85.7%), mostly overweight with a median BMI of 27.9 kg/m2 and 27.4 kg/m2, respectively. Obstructive jaundice, colicky pain, acute pancreatitis, and obstruction of the papilla were the most common symptoms in both groups. The majority of patients (68%) had one stone, whereas two or more stones were found in 32% of patients. The median diameter of the common bile duct was 9 mm in both groups. The procedure was successfully completed in all patients in the ERCP group. In the group of patients treated with LCBDE, endoscopic extraction of the stone with a Dormia basket was successfully performed in ten patients (71.4%), while in the remaining four patients (28.6%) the stones were fragmented with a laser because extraction with the Dormia basket was not possible. The median operative time was 79 min in the LCBDE group (IQR 68, 98), while it was slightly longer in the ERCP group, 85 min (IQR 74, 105) (p = 0.125). The length of hospital stay was significantly shorter in the LCBDE group (2 vs. 4 days, p = 0.011). No complications occurred in the LCBDE group, while two (40%) complications occurred in the ERCP group: pancreatitis and cholangitis (p = 0.078). During the follow-up period, no conversions, papillotomies, or recurrences were recorded in either group.
Conclusions:
Exploration of the common bile duct and removal of stones by LCBDE is safe and feasible in pediatric patients for the treatment of choledocholithiasis. Through this procedure, choledocholithiasis and cholelithiasis can be treated in a single procedure without papillotomy or fluoroscopy. Compared with LC + ERCP, LCBDE is associated with a shorter hospital stay. The incidence of complications was rather low but not statistically significant.
