Safety and efficacy of one-stage total laparoscopic treatment of common bile duct stones in children

Abstract

A one-stage total laparoscopic treatment of common bile duct stones in children is a safe, feasible, reproducible, and efficient procedure in 72% of the cases. This rate could be upgraded by a combination of laparoscopic and endoscopic technique during the same anesthesia and preserving Oddi sphincter function. These minimal invasive techniques still need to be developed in children.

Tips and Tricks—3 Use Cases of Interdisciplinary Knowledge Transfer in Minimally Invasive Pediatric Surgery

“…The intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC) has been advocated to detect intraductal calculi and biliary anomalies undetected by preoperative imaging requiring further treatment in 10% of patients [ 2 ]. However, during laparoscopic common bile duct exploration (LCBDE), irrigation with normal saline is sufficient to flush out any stones in most cases, without the need for an additional catheter or endoscopy of the common bile duct [ 3 ]. Therefore the laparoscopic common bile duct exploration is a safe alternative to ERCP in the treatment of pediatric choledocholithiasis and is recommended to be a laparoscopic-first approach in the management of choledocholithiasis with IOC to avoid unnecessary procedures in these patients [ 4 ].…”

Percutaneous management of bile duct stones in children: results of 12 cases

“…Open or laparoscopic CBD exploration is the method for removal of bile duct stones in children (11)(12)(13). The success rate of laparoscopic CBD exploration is between 60% and 87.5% with 0%-30% complication rates (11-13).…”

“…Treatment of choledocholithiasis as well as cholecystolithiasis is possible surgically as a single stage procedure (11,12). Endoscopic sphincterotomy and subsequent cholecystectomy is a two-stage procedure.…”

Percutaneous Management of Biliary Stones

“…Although surgical CBD exploration is a method for removing bile duct stones in children, the success and complication rates of the laparoscopic procedure are 60 to 87.5% and 0 to 30%, respectively. 48,49 Endoscopic method is preferred as the primary procedure for the management of pancreaticobiliary disorders in children. 50 However, the endoscopic method is not always accessible to children or not available, and is often difficult to perform due to age and size limitations in many centers.…”