Transition of Techniques to Treat Choledochal Cysts in Children

Dalton, Brian G.A.; Gonzalez, Katherine W.; Dehmer, Jeffrey J.; Andrews, Walter S.; Hendrickson, Richard J.

doi:10.1089/lap.2015.0123

Cited by 23 publications

(26 citation statements)

References 7 publications

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“…The main limitations of this study are its retrospective design and small number of patients. Precise and thorough surgical treatment is necessary to minimize early and late postoperative complications [25,26]. …”

Section: Discussionmentioning

confidence: 99%

Reoperation After Cyst Excision with Hepaticojejunostomy for Choledochal Cysts: Our Experience in 18 Cases

Sheng

et al. 2017

Med Sci Monit

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BackgroundComplete cyst excision with biliary reconstruction is the treatment of choice for choledochal cyst (CC). The aim of this article is to review our experience in patients who underwent reoperation between January 1995 and December 2014.Material/MethodsThe records of 18 patients (female/male, 15/3) were retrospectively analyzed including age, sex, cyst type, initial procedure, lab and imaging findings, indications for reoperation, intraoperative findings, and results of reoperation. The median follow-up period was 6 years.ResultsThe rate of reoperation in this study was about 6.8%. Eighteen patients (7 type Ia, 2Ic, 9 IV-A) developed severe postoperative complications and required surgical intervention. The median time interval from primary surgery to reoperation was 19.5 months (range, 3 days to 8 years). Two early complications required surgery due to anastomotic bile leakage and intussusception. Sixteen late complications occurred, including 3 intrahepatic bile duct stenosis with calculi, 5 anastomotic strictures with/without stones, 4 intrapancreatic cyst remnants, 3 adhesive bowel obstructions, and 1 internal hernia. For patients with persistent dilatation of the intrahepatic bile duct or anastomotic stricture, removal of stones and revision of hepaticojejunostomy were performed, with additional hepatic ductoplasty when necessary. Radical excision of the dilated cystic remnant in the head of pancreas was performed in 4 patients, with 1 needing additional pancreaticojejunostomy procedure. No deaths occurred. Sixteen patients recovered uneventfully after reoperation, and 2 wound infections developed.ConclusionsA wide hepaticojejunostomy with/without ductoplasty is essential to prevent cholangitis, anastomotic stricture, and calculi formation. Complete cyst excision, including the intrapancreatic portion, should be meticulously pursued.

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Section: Discussionmentioning

confidence: 99%

Reoperation After Cyst Excision with Hepaticojejunostomy for Choledochal Cysts: Our Experience in 18 Cases

Sheng

et al. 2017

Med Sci Monit

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“…Imaging tests such as B-mode ultrasound, CT and MRCP can assist in the diagnosis. Once diagnosed, early-stage surgeries should be performed to avoid the occurrence of severe complications such as cholangitis, pancreatitis, perforation of the cyst, and even canceration 5. Moreover, with the extension of the course of disease, adhesions, chronic inflammation, and expansion of the cyst could increase operative difficulty and the occurrence of postoperative complications 6.…”

Section: Discussionmentioning

confidence: 99%

“…Cyst opening or partial excision of the cyst with inner drainage has been excluded due to its associated postoperative complications including cholangitis, cholangiolithiasis, and canceration 7. Currently, the main surgical technique is cyst excision with hepatico-intestinal anastomosis including hepaticojejunostomy and hepaticoduodenostomy 8. The laparoscopic approach has the advantage of being minimally invasive with cosmetically enhanced recovery compared with the open approach.…”

Section: Discussionmentioning

confidence: 99%

“…Sufficient preoperative preparation, including gastrointestinal decompression, cleansing enema, indwelling catheterization, and bile extraction from large cysts, could help to expose the operative field fully and enlarge the operative space, making younger patients capable of enduring laparoscopic surgery 14. Additionally, younger patients usually have larger cysts and a higher possibility of cholestasis, which could easily cause cholestatic cirrhosis 5,15. For older children, due to repeated inflammation of the bile duct, cyst exteriorization would injure the surrounding tissues and even cause bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Comparative clinical study of laparoscopic and open surgery in children with choledochal cysts

Song

Jiang

Wang

et al. 2017

SMJ

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Objectives:To investigate the safety and effectiveness of laparoscopic management of choledochal cysts compared with the open approach, even in early childhood.Methods:We conducted a retrospective study of 206 patients with choledochal cysts between June 2003 and May 2015. Of these, 104 patients underwent open cyst excision and hepaticojejunostomy (open operation [OP]) and 102 patients received laparoscopic management and hepaticojejunostomy (laparoscopic operation [LP]). The patients who underwent a laparoscopic approach were further divided by the age of 3 years. We compared patients’ perioperative and follow-up conditions between the 2 approaches and the 2 age groups.Results:All patients were cured with no incidence of mortality. The operating time was significantly longer in the LP (OP: 225.4±51.0 min versus LP: 170.3±35.4 min, p=0.000), but blood loss (LP: 12.9±22.9 ml versus OP: 32.4±52.7 ml, p=0.001) was significantly larger in the OP. The number of days to normal oral feeding (LP: 3.3±0.9 dyas versus OP: 4.1±0.9 days, p=0.000) and postoperative stay-in-ward duration (LP: 7.5±2.7 days versus OP: 9.6±5.5 days, p=0.001) were significantly shorter with the LP. There were no significant differences among all of the above tests between the younger and older patients (p>0.05).Conclusions:Laparoscopic operation is safe and effective, even for young children. With the advantages of less blood loss, smaller trauma, shorter postoperative recovery time, and improved cosmetic features, it is worth considering its widespread application.

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“…Surgeons who used to perform hepaticojejunostomy now perform laparoscopic hepaticoduodenostomy . Shorter operative time is universally observed in studies comparing the two techniques . Whether this short‐term advantage can balance out the potential long‐term risk of chronic reflux leading to dysplasia or malignancy is debatable …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic management of choledochal cysts in infants and children: A review of current practice

et al. 2018

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Aim: Choledochal cyst is characterized by congenital dilatation of the biliary system. Patients with choledochal cyst tend to be symptomatic in their childhood. The aim of this study was to review the current practice in laparoscopic management of choledochal cyst in infants and children. Patients and Methods: A PubMed database search was performed for all the studies on children who underwent laparoscopic excision of choledochal cyst. Additional literature was cited second hand from the first-tier literatures. Results: Studies on i) laparoscopic excision of choledochal cyst and hepaticojejunostomy in children; ii) laparoscopic management of choledochal cyst in antenatally detected choledochal cyst; iii) single incision laparoscopic surgery (SILS) in children with choledochal cyst; iv) robotic assisted laparoscopic surgery in children with choledochal cyst and v) hepaticoduodenostomy in children with choledochal cyst were reviewed. Conclusions: Laparoscopic excision of choledochal cyst and hepaticojejunostomy remains safe and feasible in children and infants. In centers experienced in MIS, SILS and robotic-assisted laparoscopy in the management of children with choledochal cyst were reported to be an alternative approach. The debate on hepaticoduodenostomy versus hepaticojejunostomy in biliary reconstruction will continue until a longterm outcome is available in the future.

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Transition of Techniques to Treat Choledochal Cysts in Children

Abstract: Laparoscopic choledochal cyst resection with both HJ and HD reconstruction appears safe and has equivalent outcomes to open procedures in our series.

Cited by 23 publications

References 7 publications

Reoperation After Cyst Excision with Hepaticojejunostomy for Choledochal Cysts: Our Experience in 18 Cases

Reoperation After Cyst Excision with Hepaticojejunostomy for Choledochal Cysts: Our Experience in 18 Cases

Comparative clinical study of laparoscopic and open surgery in children with choledochal cysts

Laparoscopic management of choledochal cysts in infants and children: A review of current practice

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