Making common duct exploration common | Balloon sphincteroplasty as an adjunct to transcystic laparoscopic common bile duct exploration (LCBDE) for pediatric patients | Retrospective chart review | Of patients since 2018 | LCBDE-STD (standard transcystic) vs LCBDE+BSP (balloon sphincteroplasty) | 44 patients | 14 LCBDE-STD | 15 LCBDE+BSP | 15 ERCP+LC* | *ERCP+LC: ERCP pre-or-post laparoscopic cholecystectomy | Steps of balloon sphincteroplasty as an adjunct to laparoscopic common bile duct exploration (LCBDE), adapted from Bosley et al. | Operative time was longer in the LCBDE+BSP group (p =< 0.05) | LCBDE+BSP success rate >> LCBDE-STD (100% vs 78%; p = 0.06) | 3 patients who failed LCBDE-STD required postoperative ERCP | ERCP+LC patients had increased | Length of stay (4.36 ± 2.78 vs 1.31 ± 0.93; p =< 0.05) | Complications compared to LCBDE groups | Conclusion: Implementing LCBDE into standard management of pediatric choledocholithiasis may reduce length of stay and help avoid additional invasive procedures. | https://doi.org/10.1016/j.jpedsurg.2022.09.016 | Source: Rauh JL et.al. | @EmTombash | @StayCurrentMD | Department of General Surgery, Wake Forest Baptist Medical Center, NC, United States | Cincinnati Children's | Journal of Pediatric Surgery
Making common duct exploration common-balloon sphincteroplasty as an adjunct to transcystic laparoscopic common bile duct exploration for pediatric patients
Infographic · May 2023 · 1 min read
In brief
In brief
This study demonstrates that balloon sphincteroplasty during laparoscopic common bile duct exploration achieves 100% success in clearing pediatric bile duct stones, compared to 78% with standard transcystic technique. The combined approach reduces hospital stay and avoids separate ERCP procedures while using familiar surgical techniques.
- Laparoscopic common bile duct exploration with balloon sphincteroplasty achieved 100% success rate vs 78% for standard transcystic approach
- LCBDE reduces hospital stay by 3 days compared to ERCP+cholecystectomy (1.3 vs 4.4 days) with fewer complications
- Three patients who failed standard LCBDE required postoperative ERCP, suggesting sphincteroplasty prevents secondary procedures
- Balloon sphincteroplasty adds minimal fluoroscopy time while enabling definitive single-anesthetic management of pediatric choledocholithiasis
- ERCP+cholecystectomy resulted in higher complication rates including stent placements and one stent migration
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with anatomical illustrations showing the gallbladder and bile duct system. Four sequential diagrams demonstrate the steps of balloon sphincteroplasty procedure. Key findings are highlighted in colored text boxes, with statistical comparisons presented in large text. Medical icons and illustrations of healthcare providers appear throughout.
Jessica L. Rauh, Aravindh S. Ganapathy, Maggie E. Bosley, Alexa Rangecroft, Kristen A. Zeller, Leah M. Sieren, John K. Petty, Thomas Pranikoff, Lucas P. Neff
Background: Laparoscopic common bile duct exploration (LCBDE) at the time of cholecystectomy has well-established benefits for managing pediatric choledocholithiasis. However, providers increasingly favor ERCP pre-or-post laparoscopic cholecystectomy (ERCP+LC) due to perceived complexity of LCBDE. We refined a stepwise method employing wire-ready balloon dilation of the Sphincter of Oddi. This study compares outcomes of balloon sphincteroplasty (LCBDE+BSP) with standard transcystic LCBDE (LCBDE-STD) and ERCP+LC.
Methods: We performed a retrospective chart review of pediatric patients who underwent LCBDE-STD and LCBDE+BSP since 2018. A report of consecutive choledocholithiasis patients prior to 2018 yielded an ERCP+LC cohort. Age, operative time, complications, and length of stay (LOS) were compared across all groups. Success rate and fluoroscopy time were compared between LCBDE groups.
Results: 44 patients were identified (14:LCBDE-STD; 15:LCBDE+BSP; 15:ERCP+LC) . There was no difference in patient age or BMI. Operative time was longer in the LCBDE+BSP group (p =< 0.05). ERCP+LC demonstrated increased LOS (4.36 ± 2.78 vs 1.31 ± 0.93; p =< 0.05) and complications compared to LCBDE groups including three stent placements and one stent migration. LCBDE+BSP had a higher success rate than LCBDE-STD (100% vs 78%; p = 0.06). The three patients who failed LCBDE-STD required postoperative ERCP. Average fluoroscopy time was not significantly impacted by addition of sphincteroplasty.
Conclusion: Incorporating LCBDE into standard management of pediatric choledocholithiasis reduces LOS and avoids additional invasive procedures regardless of the specific technique employed. This stepwise approach to wire-ready cholangiography with balloon sphincteroplasty is a viable method for LCBDE that utilizes techniques familiar to pediatric surgeons and provides definitive management under a single anesthetic.