Perioperative cholangiogram in pediatric cholecystectomy

ABSTRACT Recently, the increased accuracy of ultrasound examinations has led to the more frequent identification of cholelithiasis. The minimally invasive approach has allowed a broader application of surgical therapy in children. We report on our experience with 43 laparoscopic cholecystectomies in children. Ultrasound examination has been used preoperatively to diagnose viscero-parietal adhesions, gallstone migration into the common bile duct, and to measure stone size and location. The etiology of gallbladder stones was of unknown origin (32% of cases), or due to hematological disorders or hyperbilirubinemia (36%), polyposis (5%), or anatomic anomalies of the cystic-choledochal junction (27%). Intraoperative cholangiography was never performed. Results were excellent, and complications were not experienced. During the follow-up, either residual concretions or stone migrations into both the choledocus and the extrahepatic biliary ducts were ruled out using ultrasound examination. The indication for chol...