Laparoscopic Resection Of Congenital Choledochal Cyst, Choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis |
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Authors: | BM Ure F Schier AI Schmidt R Nustede C Petersen NK Jesch |
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Institution: | (1) Department of Pediatric Surgery, Medical University Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany;(2) Department of Pediatric Surgery, University of Mainz, Laugenbeckstr 1, 55101 Mainz, Germany |
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Abstract: | Background The feasibility of laparoscopic resection of choledochal cyst and hepaticojejunostomy in children is still unclear. This report
presents the author’s experience with a first series of patients.
Methods Data from 11 consecutive children (median age 17.5 months, SD 22, range 2 to 70) with choledochal cyst scheduled for laparoscopy
were collected prospectively. There were nine type I and 2 type V cysts according to Todani’s classification. All except one
patient had intermittent jaundice or recurrent pancreatitis. The laparoscopic technique included excision of the cyst. A Roux-en-Y
anastomosis was constructed after exteriorization of the small bowel via the infraumbilical trocar incision. After repositioning
of the bowel an end-to-side hepaticojejunostomy was carried out laparoscopically.
Results The procedures were carried out in nine children without intraoperative events and a median duration of 289 min (SD 62). In
two patients, the operation was converted after 60 and 90 min due to a lack of overview at the dorsal margin with problems
in separation of the portal vein. Oral food intake was started within 2 days and tolerated well in all except one patient,
in whom biliar fluid from the drain led to laparoscopic reevaluation on day 1. A small leak was resutured and the patient
was discharged on day 5. In one patient, recurrent cholangitis and a dilated Roux-en-Y loop led to correction of some kinking
of the loop via laparotomy after 3 months. All other patients are well with bile-stained stools after a mean follow-up of
13 months.
Conclusions Laparoscopic resection of congenital choledochal cyst and choledochojejunostomy in children is feasible. We feel that there
is a considerable learning curve with the technique. Future studies will have to prove the feasibility of laparoscopic Roux-en-Y
bowel anastomosis without the need for bowel exteriorization. |
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Keywords: | Choledochal cyst Laparoscopy |
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