Making common duct exploration common-balloon sphincteroplasty as an adjunct to transcystic laparoscopic common bile duct exploration for pediatric patients

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 (LCBDESTD) 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. Level of evidence: Level III. (c) 2022 Elsevier Inc. All rights reserved.