Routine intraoperative cholangiography during laparoscopic cholecystectomyminimizes unnecessary endoscopic retrograde cholangiopancreatography in children

Purpose: The aim of this study was to determine the necessity for intraoper ative cholangiography (IOC) during pediatric laparoscopic cholecystectomy ( LC). Methods: A retrospective review of 100 consecutive patients undergoing LC w as conducted. Results: Ninety-eight children underwent successful LC. The average age was 11.3 years. IOC was successful in 55 of 63 studies. Operating time for pat ients with IOC averaged 91 minutes, and without IOC, 67 minutes. Twenty chi ldren had preoperative ultrasound, laboratory, or clinical evidence of comm on bile duct (CBD) stones. Fifteen of these 20 children actually had CBD st ones. Three additional children who lacked any ultrasound, clinical, or lab oratory evidence of choledocholithiasis had unsuspected CBD stones. Eight c hildren, therefore, had ultrasound, clinical, or laboratory findings not pr edictive of the actual state of the CBD. Sixteen children underwent endosco pic retrograde cholangiopancreatography (ERCP), 9 preoperatively and 7 post operatively. Four preoperative ERCP studies showed no CBD stones. There wer e no complications from performing IOC. Conclusions: (1) CBD stones are common in children with gallstones, (18 of 100 patients). (2) Preoperative studies and clinical findings may not predi ct accurately the presence or absence of CBD stones. (3) IOC should be rout inely performed in children before the use of ERCP to avoid unnecessary ERC P unless CBD stones are specifically visualized by ultrasound scan. J Pedia tr Surg 36:881-884. Copyright (C) 2001 by W.B. Saunders Company.