THE MANAGEMENT OF CHOLEDOCHOLITHIASIS IN CHILDREN IN THE ERA OF LAPAROSCOPIC CHOLECYSTECTOMY

Although laparoscopic cholecystectomy has become the procedure of choi ce for gallbladder removal in children, the treatment of children who have choledocholithiasis remains unclear For adults who have suspected choledocholithiasis, preoperative endoscopic retrograde cholangiopanc reatography (ERCP) is a well-described and effective approach, however , its use for common bile duct stones in children has not been defined . The authors reviewed the records of 131 consecutive children undergo ing laparoscopic cholecystectomy on two surgical services to define th e efficacy of ERCP followed by laparoscopic cholecystectomy in managin g choledocholithiasis in children. Fourteen children were suspected of having common duct stones noted on preoperative ultrasound scan and l aboratory data. At ERCP, six children had no stones visualized; eight had stones and underwent stone extraction and sphincter dilation or sp hincterotomy, All 14 underwent laparoscopic cholecystectomy a mean of 3.8 days after ERCP. None of the 14 had evidence of retained stones, O nly one of 117 children undergoing primary laparoscopic cholecystectom y had unsuspected common bile duct stones and was treated with laparos copic common bile duct exploration and stone removal, A management pla n incorporating ERCP followed by early laparoscopic cholecystectomy is a safe and effective strategy for children who have choledocholithias is. Copyright (C) 1997 by W.B. Saunders Company.