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.