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Total laparoscopic approach for choledocho lithiasis is doing as well as the shincterotomy

Benedicte Boimond Aulagne, Annabel Paye Jaouen, Souhayl Dahmani, Guilaine Ithier, Alaa El, Ghnoneimi, Arnaud Bonnard

Robert Debré Children University Hospital, Paris, France

 

Abstract 

Aim of the study: to report the results of a total laparoscopic approach for choledoco-lithiasis as a primary treatment before the sphincterotomy.
Patients and method: It’s a retrospective study of all children treated in our center for choledoco lithiasis from 1996 to 2012. A trans cystic approach for all the procedures was used. Patient’s data, technic, complications and results were reviewed.
Results: 33 children were treated. The average age at surgery was 10 years [4 months-18 years]. 16 patients have a sickle cell disease (48.5%), 5 a spherocytosis (15.1%), 1 a G6PD insufficiency, 1 thalassemia, 1 an ulcerative colitis, 1 a nephrotic syndrome and 8 were idiopathic (21.1%). All children have a US exam showing a choledoco lithiasis and a cholestasis on the pre operative blood work. For all cases, a cholecystectomy was done firstly. On nineteen patients, the lithiasis was seen on the operative cholangiography and flushed with normo saline fluid. Additionally, 9 required the use of a dormia or fogarty catheter trying to clean the duct. On the remaining 14 patients, the lithiasis was not seen, probably already flushed by the operative contrast study. 3 patients required a post operative sphincterotomy because we failed to clean the chodedocal duct. One patient has a persistent image on the cholangiography but not needing a sphincterotomy. Finally, 29 patients were stone free (88%). There were 3 complications (9%): a chodedochal duct injury requiring a conversion to open approach, 2 hemorrages related to a cystic artery stump. The average hospital stay was 9 days. All children are doing well with a 2 years average follow up.
Conclusion: treatment of choledoco lithiasis should be attempted by laparoscopic approach prior to a sphincterotomy. In 88%, it allowed to clean the choledochal duct with a minimal complication rate.