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.
| Published in | American Journal of Pediatrics (Volume 3, Issue 2) |
| DOI | 10.11648/j.ajp.20170302.11 |
| Page(s) | 4-7 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2017. Published by Science Publishing Group |
On-Table-Cholangiogram, Laparoscopic, Cholecystectomy, Gallstones, Bile Duct, Guidelines
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APA Style
Roy Gurprashad, Alex Oldman, Jessica Burns, Joe Curry. (2017). Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy. American Journal of Pediatrics, 3(2), 4-7. https://doi.org/10.11648/j.ajp.20170302.11
ACS Style
Roy Gurprashad; Alex Oldman; Jessica Burns; Joe Curry. Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy. Am. J. Pediatr. 2017, 3(2), 4-7. doi: 10.11648/j.ajp.20170302.11
AMA Style
Roy Gurprashad, Alex Oldman, Jessica Burns, Joe Curry. Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy. Am J Pediatr. 2017;3(2):4-7. doi: 10.11648/j.ajp.20170302.11
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Download@article{10.11648/j.ajp.20170302.11,
author = {Roy Gurprashad and Alex Oldman and Jessica Burns and Joe Curry},
title = {Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy},
journal = {American Journal of Pediatrics},
volume = {3},
number = {2},
pages = {4-7},
doi = {10.11648/j.ajp.20170302.11},
url = {https://doi.org/10.11648/j.ajp.20170302.11},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20170302.11},
abstract = {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.},
year = {2017}
}
TY - JOUR T1 - Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy AU - Roy Gurprashad AU - Alex Oldman AU - Jessica Burns AU - Joe Curry Y1 - 2017/03/21 PY - 2017 N1 - https://doi.org/10.11648/j.ajp.20170302.11 DO - 10.11648/j.ajp.20170302.11 T2 - American Journal of Pediatrics JF - American Journal of Pediatrics JO - American Journal of Pediatrics SP - 4 EP - 7 PB - Science Publishing Group SN - 2472-0909 UR - https://doi.org/10.11648/j.ajp.20170302.11 AB - 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. VL - 3 IS - 2 ER -
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