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Sequential endoscopic/laparoscopic management of cholelithiasis and choledocholithiasis in children who have sickle
1Department of Surgery, Qatif Central Hospital, Saudi Arabia.
Insights
Gallstones and bile duct stones are common in sickle cell disease (SCD). A sequential approach of ERCP for stone removal followed by laparoscopic cholecystectomy is safe and effective for children with SCD.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
- Hematology
Background:
- Cholelithiasis and choledocholithiasis are frequent complications in children with sickle cell disease (SCD).
- Laparoscopic cholecystectomy (LC) is increasingly used for gallstone management in these patients.
- Accurate exclusion of choledocholithiasis is crucial prior to LC in children with SCD.
Purpose of the Study:
- To evaluate a sequential approach for managing cholelithiasis and choledocholithiasis in children with SCD.
- To determine the safety and efficacy of ERCP followed by LC.
Main Methods:
- Retrospective review of 18 children with SCD, cholelithiasis, and choledocholithiasis.
- Treatment modalities included open cholecystectomy (OC) with common bile duct (CBD) exploration, transduodenal sphincteroplasty, and ERCP with sphincterotomy and stone extraction followed by LC.
- Focus on the 11 patients who underwent the sequential ERCP-LC approach.
Main Results:
- Clinical and laboratory findings (dilated CBD on ultrasound, elevated alkaline phosphatase, elevated total bilirubin >5 mg/dL, pancreatitis history) suggest choledocholithiasis.
- Patients with suspected or confirmed choledocholithiasis benefited from ERCP for stone detection and extraction prior to LC.
- The sequential ERCP-LC approach was successfully applied in 11 pediatric SCD patients.
Conclusions:
- A sequential strategy involving ERCP for stone removal followed by LC is safe and effective for pediatric SCD patients with cholelithiasis and choledocholithiasis.
- This approach minimizes the risk of retained bile duct stones during LC.
- Highlights the importance of pre-LC evaluation for choledocholithiasis in this specific population.
Background/Purpose:
Cholelithiasis and choledocholithiasis are common complications of sickle cell disease (SCD). With the recent advances in laparoscopic cholecystectomy (LC), which has been used successfully for the management of cholelithiasis in children who have SCD, exclusion of choledocholithiasis before LC is of great importance.
Methods:
Eighteen children who had SCD, cholelithiasis, and choledocholithiasis were treated at our hospital. Seven were treated with open cholecystectomy (OC) and common bile duct (CBD) exploration, and two were treated with transduodenal sphincteroplasty. The remaining 11 patients underwent endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, and stone extraction followed by laparoscopic cholecystectomy (LC).
Results:
A dilated CBD noted on ultrasound, elevated alkaline phosphatase, elevated total bilirubin of more than 5 mg/dL, history of pancreatitis, either singly or in combination, should raise suspicion of choledocholithiasis, and these patients together with those who have choledocholithiasis detected on ultrasound should undergo ERCP to confirm and extract the stones before LC.
Conclusion:
This sequential approach of endoscopic sphincterotomy and stone extraction followed by LC is a safe and effective approach for the management of cholelithiasis and choledocholithiasis in children who have SCD.