American Journal of Pediatrics
Volume 3, Issue 2, March 2017, Pages: 4-7
Received: Feb. 17, 2017;
Accepted: Mar. 2, 2017;
Published: Mar. 21, 2017
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Roy Gurprashad, Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Children’s Hospital, London, United Kingdom
Alex Oldman, Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Children’s Hospital, London, United Kingdom
Jessica Burns, Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Children’s Hospital, London, United Kingdom
Joe Curry, Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Children’s Hospital, London, United Kingdom
The use of on table cholangiogram (OTC) during laparoscopic cholecystectomy (LC) continues to be a debated topic within surgical practice. Current National Institute for Health and Care Excellence (NICE) guidelines do not advocate its routine use in adult patients, and there is scarce evidence for its use in paediatric cases. We aimed to analyse the outcomes of OTC during laparoscopic cholecystectomy to see if the NICE guidance holds true for children. A retrospective case note review was performed with IRB approval of all children who underwent laparoscopic cholecystectomy between February 2005 and November 2014. A total of 65 patients were identified, 41 female (63%) and 24 male (37%). The median age was 12 years (IQR 6). None of the patients underwent OTC during their LC. Instead, pre-operative ultrasound scan (USS) was performed in all cases. From the cohort, 5 patients (13%) showed abnormalities; 3 of which had a dilated common bile duct, and 2 of which had bile duct stones. All 5 patients went on to receive additional imaging, 2 patients underwent a repeat USS both of which were normal on review; 1 patient had an Endoscopic Retrograde Cholangio-Pancreatectography (ERCP), stent and follow-up Magnetic Resonance Cholangio-Pancreatograthy (MRCP) which was normal; 1 patient had an MRCP, ERCP with sphincterotomy and a follow-up USS which was normal; and 1 patient had an ERCP with follow-up USS which was also normal. In line with current NICE guidance for adults, our study indicates that patients with common bile duct (CBD) stones or a dilated CBD can be identified and managed prior to laparoscopic cholecystectomy. This would suggest that there is no requirement for OTC in children. Similar NICE guidance in Paediatrics may be necessary to avoid unnecessary intervention.
Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy, American Journal of Pediatrics.
Vol. 3, No. 2,
2017, pp. 4-7.
Chan S, Currie J, Malik A, Mahomed A. Paediatric cholecystectomy: Shifting goalposts in the laprascopic era. Surgical Endoscopy 2008; 22: 1392-1395.
NICE. Single-incision laparoscopic cholecystectomy, interventional procedure guidance 508. 2014.
Tabone LE, Sarker S, Fisichella M, Conlon M, Fernando E, Yi S, Luchette FA. To ‘gram or not’? Indications for intraoperative cholangiogram. Surgery 2011; 150: 810-9.
Sharma AK, Cherry R, Fielding JWL. A randomised trial of selective or routine on-table cholangiography. Annals of the Royal College of Surgeons of England 1993; 75: 245-248.
Livingstone EH, Miller JAG, Coan B, Rege RV. Costs and utilisation of intra-operative cholangiography. The Society for Surgery of the Alimentary Tract 2007; 11: 1162-1167.
Sajid MS, Leaver C, Haider Z, Worthington T, Karanjia N, Singh KK. Routine on-table cholangiography during cholecystectomy: a systematic review. Annals of the Royal College of Surgeons of England 2012; 94: 375-380.
Khan OA, Balaji S, Branagan G, Bennett DH, Davies N. Randomised clinical trial of routine on-table cholangiography during laparoscopic cholecystectomy. British Journal of Surgery 2010; 98 (3): 362-367.
St Peter SD, Keckler SJ, Nair A, et al. Laparoscopic cholecystectomy in the pediatric population. J Laparoendosc Adv Surg Tech. Part A. 2008; 18: 127-130.
Zeidan MM, Pandian TK, Ibrahim KA, Moir CR, Ishitani MB, Zarroug AE. Laparoscopic Cholecystectomy in the Pediatric Population: A Single-centre Experience. Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 2014; 24 (3): 248-250.
Davenport M. Laparoscopic surgery in children. Annals of the Royal College of Surgeons of England 2003; 85: 324-330.
Koivusalo AI, Pakarinen MP, Sittiwet C, Gylling H, Miettinen TA, Miettinen TE, Nissinen MJ. Cholesterol, non-cholesterol sterols and bile acids in paediatric gallstones. Digestive and Liver Disease 2010; 42 (1): 61-66.
Kim PC, Wesson D, Superina R, Filler R. Laparoscopic Cholecystectomy Versus Open Cholecystectomy in Children: Which is Better? Journal of Paediatric Surgery 1995; 30 (7): 971-973.
Jawas AJ, Kurban K, el-Bakry A, al-Rabeeah A, Seraj M, Ammar A. Laparoscopic Cholecystectomy for cholelithiasis during infancy and childhood: cost analysis and review of current indications. World J Surg 1988; 22 (1): 69-73.
Pichler J, Watson T, McHugh K and Hill S. Prevalence of Gallstones Compared in Children with Different Intravenous Lipids. J Pediatr Gastroenterol Nutr 2015; 61 (20): 253-259.
Colomb V, Goulet O, Rambaud C, De Potter S, Sadoun E, Ben Hariz M et al. (1992). Long-term parenteral nutrition in children: liver and gallbladder disease. Transplant Proc 24, 1054–1055.
Gowda DJ, Agarwal P, Bagdi R, Subramanian B, Kumar M, Ramasundaram M, Paramasamy B, Khanday ZS. Laparoscopic cholecystectomy for cholelithiasis in children. J Indian Assoc Pediatr Surg 2009; 14: 204-6.
Hamad MA, Nada AA, Abdel-Atty MY, Kawashti AS. Major Biliary Complications in 2,714 cases of laparascopic cholecystectomy without intraoperative cholangiography: a multicentre retrospective study. Surg Endosc 2011; 25: 3747-3751.
Kharbutli B, Velanovich V. Management of preoperatively suspected choledocholithiasis: A decision analysis. Journal of Gastrointestinal Surgery; 12 (11): 1973-1980.
Metcalfe MS, Ong T, Bruening MH, Iswariah H, Wemyss-Holden SA, Maddern GJ. Is laparascopic intraoperative cholangiogram a matter of routine? The American Journal of Surgery 2004; 187: 475-481.