Related Experiment Video
Updated: Jul 11, 2025
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis: A Multi-Center
Jessica Rauh1, Goeto Dantes2, Marshall Wallace3
1Wake Forest School of Medicine, Winston Salem, USA.
Insights
Upfront laparoscopic cholecystectomy with intraoperative cholangiogram and common bile duct exploration significantly reduces interventions and hospital stay for pediatric choledocholithiasis. This approach offers a safer, more efficient alternative to traditional methods.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Choledocholithiasis in children often requires endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC).
- An alternative approach involves upfront LC with intraoperative cholangiogram (IOC) and possible laparoscopic common bile duct exploration (LCBDE), potentially avoiding ERCP.
Purpose of the Study:
- To evaluate if upfront LC + IOC ± LCBDE decreases length of stay (LOS) and the total number of interventions for children with suspected choledocholithiasis compared to preoperative ERCP followed by LC.
Main Methods:
- A multicenter, retrospective cohort study of pediatric patients (<18 years) from 2018-2022 with suspected choledocholithiasis.
- Comparison of outcomes between upfront LC + IOC ± LCBDE (OR1st) and preoperative ERCP prior to LC (OR2nd).
- Complications included postoperative pancreatitis, recurrent choledocholithiasis, bleeding, or abscess.
Main Results:
- 252 children were analyzed (OR1st: n=156, OR2nd: n=96).
- The upfront approach (OR1st) resulted in fewer complications (3/156 vs. 15/96) and shorter LOS (2.39 vs. 3.84 days, p<0.05).
- Of patients undergoing LCBDE (72/156), 86% had definitive intraoperative management, with 14% requiring postoperative ERCP.
Conclusions:
- Upfront LC + IOC ± LCBDE is associated with fewer ERCPs, lower LOS, and decreased complications in pediatric choledocholithiasis.
- Postoperative ERCP remains crucial for patients who do not achieve successful common bile duct clearance with LCBDE.
- Enhanced training in IOC and LCBDE for pediatric surgeons is recommended to improve outcomes.
Background:
Patients with choledocholithiasis are often treated with endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). Upfront LC, intraoperative cholangiogram (IOC), and possible transcystic laparoscopic common bile duct exploration (LCBDE) could potentially avoid the need for ERCP. We hypothesized that upfront LC + IOC ± LCBDE will decrease length of stay (LOS) and the total number of interventions for children with suspected choledocholithiasis.
Methods:
A multicenter, retrospective cohort study was performed on pediatric patients (<18 years) between 2018 and 2022 with suspected choledocholithiasis. Demographic and clinical data were compared for upfront LC + IOC ± LCBDE and possible postoperative ERCP (OR1st) versus preoperative ERCP prior to LC (OR2nd). Complications were defined as postoperative pancreatitis, recurrent choledocholithiasis, bleeding, or abscess.
Results:
Across four centers, 252 children with suspected choledocholithiasis were treated with OR1st (n = 156) or OR2nd (n = 96). There were no differences in age, gender, or body mass index. Of the LCBDE patients (72/156), 86% had definitive intraoperative management with the remaining 14% requiring postoperative ERCP. Complications were fewer and LOS was shorter with OR1st (3/156 vs. 15/96; 2.39 vs 3.84 days, p < 0.05).
Conclusion:
Upfront LC + IOC ± LCBDE for children with choledocholithiasis is associated with fewer ERCPs, lower LOS, and decreased complications. Postoperative ERCP remains an essential adjunct for patients who fail LCBDE. Further educational efforts are needed to increase the skill level for IOC and LCBDE in pediatric patients with suspected choledocholithiasis.
Level Of Evidence:
Level III.
