Laparoscopic micro-incision technique at cystic duct confluence for pediatric choledocholithiasis management: A case...

The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage. This case report introduces a novel laparoscopic microincision technique at the cystic duct confluence, designed to eliminate T-tube dependence, minimize ductal trauma, and expedite recovery, which are critical priorities for active children. We present this innovation to address unmet pediatric-specific surgical needs and demonstrate its feasibility as a tailored, minimally invasive solution for choledocholithiasis in children.

A 12-year-old girl with a 5-year history of recurrent upper abdominal pain was diagnosed with choledocholithiasis, cholelithiasis, and biliary pancreatitis based on imaging and laboratory tests. After failed conservative management, laparoscopic cholecystectomy with a microincision at the cystic duct confluence enabled choledochoscopic extraction of seven stones without T-tube placement. Primary closure using absorbable sutures with cystic duct confluence preserved biliary integrity. Postoperatively, liver function and amylase levels normalized by day 3, and abdominal ultrasonography confirmed no complications. The patient promptly resumed normal activity with no recurrence observed at the 16-month follow-up visit. This approach avoids external drainage, minimizes ductal manipulation, and optimizes recovery, which are key advantages for pediatric patients.

Microincision at the cystic duct confluence safely eliminates T-tubes, ensures stone clearance, and accelerates pediatric recovery.