WOFAPS 2025 8th World Congress of Pediatric Surgery

SUHA MOHMMEDNOUR, noora alshawani, Hassan baghazal, Saleem Mamoo, Mansour Ali, Guy Brisseau, Nordeen Bouhadiba

Sidra Medicine, Qatar

Surgery-First with clearance of choledocholithiasis in pediatric. Innovative approach

Introduction:

The rate of biliary stones disease in the pediatric population is rising, report from 0.13% up to 6.1% with specific complications as choledocholithiasis and biliary duct obstruction.There is no clear current consensus regarding the management of Choledocholithiasis in children; particularly regarding whether intraoperative cholangiogram -IOC- with laparoscopic common bile duct -CBD- exploration should be first or endoscopic retrograde cholangiopancreatography -ERCP- either pre or post laparoscopic cholecystectomy.

we describe a new approach of surgery first with la paroscopic clearance of the choledocholithiasis in pediatric without ERCP either pre or post op

Methods

From 1^st of January 2020 to 30^th June 2025, we reviewed all our pediatric laparoscopic cholecystectomies with particular regard of a novel management of the cholelithiasis. During the IOC, we measure the size of the stones within the CBD.

Dormia basket is introduced through cystic duct and retrograde removal of stones. should this be unsuccessful we try Fogarty retrograde removal stones and if this is unsuccessful we then dilate Oddi sphincter with the corresponding Fogarty size and flush the stones out in anterograde manner.

Results:

45 patients had laparoscopic cholecystectomies. Within these; 15 patients had IOC, 30 patients did not. within these 15 patients, 5 had positive IOC. There were 3 girls (9,12 and 13 years) and two boys (9 and 15years) old, mean age 12.

All five patients become asymptomatic with ultrasonic normalization of CBD size and biologic normalization of the liver function. Patient were discharged on day 2 post op.

No ERCP was necessary either preop or post op

Conclusion:

Surgery first approach is entirely safe and feasible in children with CBD stones. The use of the Dormia basket for anterograde and the Fogarty for Oddi sphincter dilation and retrograde stone removal have been entirely successful with no complications. The use of pre or post op ERCP in children has a reported complication rate up to 9% in children. Specificity in children are technical difficulties and the need of highly skilled endoscopic team.

Short term complications of sphincterotomy are pancreatitis, hemorrhages, sepsis, and perforations. Long-term complications are cholangitis and minor papilla restenosis.

We recommend the surgery first approach and limit the advanced approaches (ERCP, choledochotomy) to the failed stones removal by surgery first