Chen GB, Sha YG, Wang ZL, Wang DB, Tang RM, Chen YS. Laparoscopic micro-incision technique at cystic duct confluence for pediatric choledocholithiasis management: A case report. World J Gastrointest Surg 2025; 17(5): 105894 [DOI: 10.4240/wjgs.v17.i5.105894]
Corresponding Author of This Article
Yi-Sheng Chen, MD, Chief Physician, Professor, Department of General Surgery, Wuhu Guangji Hospital, No. 19 Zheshan Middle Road, Jinghu District, Wuhu 241000, Anhui Province, China. chenyisheng1953@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Guang-Bin Chen, Ding-Bang Wang, Rong-Mei Tang, Department of Hepatobiliary Surgery, The Second People’s Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu 241000, Anhui Province, China
Guang-Bin Chen, Yan-Guang Sha, Zhi-Lin Wang, Graduate School, Wannan Medical College, Wuhu 241000, Anhui Province, China
Yi-Sheng Chen, Department of General Surgery, Wuhu Guangji Hospital, Wuhu 241000, Anhui Province, China
Co-first authors: Guang-Bin Chen and Yan-Guang Sha.
Co-corresponding authors: Rong-Mei Tang and Yi-Sheng Chen.
Author contributions: Chen GB and Sha YG contributed equally to this work as co-first authors; Tang RM and Chen YS designed the overall concept and outline of the manuscript, they contributed equally as co-corresponding authors; Chen GB, Sha YG, and Wang DB performed the surgical procedure and wrote the paper; Wang ZL and Wang DB managed the patient; Chen GB, Sha YG, Chen YS, and Wang ZL contributed to the discussion and design of the manuscript and edited the pictures; all authors have read and approve the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Sheng Chen, MD, Chief Physician, Professor, Department of General Surgery, Wuhu Guangji Hospital, No. 19 Zheshan Middle Road, Jinghu District, Wuhu 241000, Anhui Province, China. chenyisheng1953@163.com
Received: February 10, 2025 Revised: March 15, 2025 Accepted: April 3, 2025 Published online: May 27, 2025 Processing time: 102 Days and 20 Hours
Abstract
BACKGROUND
The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage. This case report introduces a novel laparoscopic microincision technique at the cystic duct confluence, designed to eliminate T-tube dependence, minimize ductal trauma, and expedite recovery, which are critical priorities for active children. We present this innovation to address unmet pediatric-specific surgical needs and demonstrate its feasibility as a tailored, minimally invasive solution for choledocholithiasis in children.
CASE SUMMARY
A 12-year-old girl with a 5-year history of recurrent upper abdominal pain was diagnosed with choledocholithiasis, cholelithiasis, and biliary pancreatitis based on imaging and laboratory tests. After failed conservative management, laparoscopic cholecystectomy with a microincision at the cystic duct confluence enabled choledochoscopic extraction of seven stones without T-tube placement. Primary closure using absorbable sutures with cystic duct confluence preserved biliary integrity. Postoperatively, liver function and amylase levels normalized by day 3, and abdominal ultrasonography confirmed no complications. The patient promptly resumed normal activity with no recurrence observed at the 16-month follow-up visit. This approach avoids external drainage, minimizes ductal manipulation, and optimizes recovery, which are key advantages for pediatric patients.
CONCLUSION
Microincision at the cystic duct confluence safely eliminates T-tubes, ensures stone clearance, and accelerates pediatric recovery.
Core Tip: We present a novel microincision technique at the cystic duct confluence during laparoscopic common bile duct exploration for pediatric choledocholithiasis. By avoiding T-tube placement, critical for active children requiring unrestricted movement and timely return to school, this approach minimizes ductal trauma, preserves biliary integrity, and accelerates recovery. A 12-year-old patient achieved rapid normalization of liver function and symptom resolution with no recurrence at the 16-month follow-up visit. This innovation addresses pediatric-specific anatomical and lifestyle challenges, offering a safer, minimally invasive alternative to conventional methods. This technique underscores the need for surgical strategies tailored to the unique needs of children.
