title: Laparoscopic exploration of the common bile duct to relieve choledocholithiasis in children.
abstract: OBJECTIVE
  The optimal method of managing paediatric choledocholithiasis is controversial. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy are effective in adults; however, the long-term outcome in the paediatric population is unknown. We report our experience with laparoscopic common bile duct (CBD) exploration to relieve choledocholithiasis in children and propose a management algorithm.
  
  
  METHODS
  A retrospective chart review of 124 children, who underwent cholecystectomy over 5 years was conducted. Data collected included age at onset, duration of symptoms, length of stay, method of relieving choledocholithiasis and postoperative outcome.
  
  
  RESULTS
  Mean age was 12.5 years (range 10-14 years). 102 cholecystectomies were performed laparoscopically. Following intraoperative cholangiogram (IOC), choledocholithiasis was identified in eight patients. In three cases, the CBD was flushed with normal saline via a 5F ureteral catheter successfully relieving the obstruction. In three cases, a Dormia basket was used to break down the stone. Two cases required postoperative ERCP and sphincterotomy to successfully extract the stones. All children were symptom-free at follow-up with no complications reported to date.
  
  
  CONCLUSIONS
  Laparoscopic CBD exploration with Dormia basket or saline flushes to relieve choledocholithiasis is a safe and effective alternative in children. If unsuccessful, ERCP and sphincterotomy can be performed in centres with adequate resources and expertise.
authors.affiliation: Department of Paediatric Surgery, Sydney Childrens' Hospitals Network, Westmead Campus, Sydney, NSW, 2145, Australia. Seemam1@chw.edu.au
authors.forename: Seema
authors.initials: S
authors.lastname: Menon
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Patel
authors.forename: Eilen
authors.initials: E
authors.lastname: Saekang
authors.forename: Gordon
authors.initials: G
authors.lastname: Thomas
authors.forename: Soundappan
authors.initials: S
authors.lastname: Soundappan
authors.forename: Albert
authors.initials: A
authors.lastname: Shun
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015529:Choledochal Cyst / Q000601:surgery; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D012189:Retrospective Studies; D013103:Spherocytosis, Hereditary / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic