Techniques of common bile duct exploration in pediatric surgery

With the rising of incidents in pediatric cholelithiasis, pediatric surgeons are increasingly encountering patients with choledocholithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) has long been considered the gold standard for diagnosis and treatment, offering rapid relief of biliary obstruction- sometimes without general anesthesia. However, ERCP is not without risks and in the pediatric population is often limited by institutional availability, occasionally requiring interfacility transfer and escalating healthcare costs. Recently, transcystic laparoscopic common bile duct exploration (LCBDE) has emerged as a safe and effective alternative in pediatric patients, despite earlier concerns regarding anatomical feasibility. Once cystic duct access is achieved, simple techniques such as saline flushing may suffice for duct clearance while more advanced maneuvers-such as sphincter balloon dilation, stone retrieval with wire baskets, and direct choledochoscopy-can be performed when needed. This manuscript provides a practical guide for pediatric surgeons performing LCBDE and outlines key technical strategies to enhance procedural success.