Is perioperative cholangiography necessary in children undergoing elective laparoscopic cholecystectomy?
BACKGROUND
The necessity of carrying out pre- or intra-operative imaging of the biliary tree to rule out a possible anatomical abnormality or the presence of common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC) is debated. We prospectively assessed the risk of developing symptoms related to bile duct injury or CBD stones after LC in children not receiving peri-operative cholangiography.


METHODS
All patients <or= 14 years undergoing elective LC at our institution from January 2003 to June 2005 were included in this study. Peri-operative cholangiography of the CBD was not performed unless there was a suspicion of CBD stones based on clinical examination, liver biochemistry, serum amylase levels or liver ultrasound scan. Patients were prospectively followed up, looking for possible symptoms or clinical, biochemical and radiological signs related to bile duct injury or CBD stones.


RESULTS
Twenty-six patients fulfilled the inclusion criteria. The median age at elective LC was 9.8 (4.1 - 14.3) years. Surgery was uneventful in all patients. All patients were discharged on postoperative day 1. None developed early symptoms of stone migration. USS performed 1 month after surgery did not show dilatation of the biliary system or stones in the CBD in any patient and no patient developed symptoms related to CBD stones after a median postoperative follow-up of 25 (6 - 37) months.


CONCLUSIONS
Patients scheduled for elective LC presenting with unremarkable clinical examination, normal liver biochemistry and serum amylase levels, and without dilatation of the biliary tree on ultrasound scan do not need pre- or intra-operative cholangiography.
Mattioli
G
G
Department of Paediatric Surgery, G. Gaslini Research Institute, University of Genoa, Genoa, Italy. girolamomattioli@ospedale-gaslini.ge.it
Pini-Prato
A
A
Castagnetti
M
M
Gandullia
P
P
Toma
P
P
Jasonni
V
V
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D003937:Diagnosis, Differential; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome