Minimally-invasive neonatal surgery: laparoscopic excision of choledochal cysts in neonates

Abstract

Purpose Improvements in surgical techniques and a better understanding of the unique anesthetic requirements in neonates undergoing laparoscopy have suggested that laparoscopic surgery may be effective in newborns. This study therefore evaluated the safety and feasibility of laparoscopic excision of the cyst (LEC) in neonates. Methods This retrospective study included 43 neonates who underwent excision of choledochal cysts between November, 2001, and January, 2018, including 21 who underwent open excision and 22 who underwent LEC. Their perioperative and surgical outcomes were reviewed. The patients were followed up for a median 37 months (range, 3–141 months). Results Baseline characteristics did not differ significantly in the open and LEC groups. Mean intraoperative peak partial pressure of arterial CO 2 (PaCO 2 ) (45.5 mmHg vs. 48.0 mmHg) and total operation time (208.3 ± 71.0 minutes vs. 235.0 ± 47.2 minutes) were similar in both groups. Parents of the patients in the LEC group provided a more positive evaluation of scar scale and greater satisfaction with wound. No patient in either group experienced any critical complications. Three patients in the open excision group required readmission for cholangitis and 2 patients had ileus. No patient in the laparoscopic excision group experienced any postoperative complications during follow-up. Conclusion Despite difficulties performing laparoscopic surgery in neonates, LEC was safe and feasible when intraperitoneal peak pressure was maintained under 10 mmHg and PaCO 2 was closely monitored by a pediatric anesthesiologist. Compared with open excision, LEC provided improved cosmetic outcomes without severe complications. Prospective randomized studies with large numbers of patients are warranted.

Comparison of efficacy and safety of laparoscopic excision and open operation in children with choledochal cysts: A systematic review and update meta-analysis

“…Of the above 18 studies, 4 studies were further excluded due to the results of NOS, with score being � 5 stars, which were considered as indicative of low quality. Finally, in total, our analysis included 14 [14][15][16][17][18][19][20][21][22][23][24][25][26][27] retrospective cohort studies comparing LA and OP in the children with CDCs, with 1767 patients (853 in the LA group, 914 in the OP group) enrolled. A flowchart of our analysis protocol has shown in Fig 1. The characteristics and the quality of these 14 studies are listed in Table 1.…”

“…Five studies [18,19,25,27,28] compared the intraoperative blood transfusion, including a total of 1360 patients (690 in LA, 670 in OP, Table 2). The pooled results showed a higher rate of intraoperative blood transfusion in the OP group.…”

“…Eleven trials [18][19][20][21][22][23][25][26][27][28][29] with a total of 1478 patients (746 and 732 who underwent LA and OP, respectively; Table 2) investigated the LOS. Seven studies showed the LOS to be higher in the LA group, whereas 4 showed it to be lower in the OP group.…”

“…All included studies [17][18][19][20][21][22][23][24][25][26][27][28][29][30] contributed data, including 1767 patients (853 in the LA group, 914 in the OP group; Table 2). Total patient morbidity was 53/853 in the LA group and 178/914 in the OP group.…”

Total Versus Conventional Laparoscopic Cyst Excision and Roux-en-Y Hepaticojejunostomy in Children with Choledochal Cysts: A Case-Control Study

“…Although cysts are benign lesions, they are closely related to many serious complications, such as malignant bile duct tumors, cholangitis, pancreatitis and intrahepatic bile duct stones [2,11]. Therefore, surgery should be performed as soon as possible after the diagnosis is clear [12,13].…”