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Yaghi M, Jaafar R, Kanso M, Khalife M, Faraj W. Choledochal anomalies in adults: A 20-year single-center retrospective cohort experience in the Middle East. Arab J Gastroenterol 2022; 23:235-240. [PMID: 36371373 DOI: 10.1016/j.ajg.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/31/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND STUDY AIMS Choledochal cysts are rare congenital cystic dilatations of the bile ducts that occur in fewer than 1% of individuals. The disease is common in East Asia, and most of the literature concerns those populations, but some data about Western populations have been published recently. Long-term reports about the disease in Middle Eastern populations, however, are currently lacking. We report a single-center 20-year experience in diagnosing and managing choledochal anomalies. PATIENTS AND METHODS Participants were adult patients in whom choledochal cysts were diagnosed over a 20-year (2000-2019) period at a single tertiary academic care center. Clinical data, including radiologic imaging findings, were retrieved from the patients' medical records. To describe the baseline characteristics of the population, we calculated descriptive statistics. RESULTS Choledochal anomalies were diagnosed in 19 adult patients, whose median age was 30 years (interquartile range [IQR], 23-67 years). Of the choledochal cysts 13 (68.4%) were classified as Todani type I, 4 (21.1%) as Todani type IV, and 3 (15.8%) as Todani type V (Caroli's disease). No patient had underlying chronic liver disease, and liver synthetic function was preserved in all. Eighteen patients (94.7%) underwent surgery: cyst excision with Roux-en-Y hepaticojejunostomy in 17 and liver transplantation in 1. All 18 survived surgery, and the median postoperative hospital stay was 11 days (IQR, 5-34 days). All 18 were alive 90 days after surgery, and the median follow-up period was 40 months (IQR, 12-140 months). Seven patients (36.8%) developed postoperative surgical complications; 2 patients required rehospitalization, and 1 required reoperation. CONCLUSION This description of adults with choledochal cysts is the latest long-term report about this disease in the Middle East. In our 20-year experience, the disease characteristics in our patients were moderately consistent with those described previously.
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Affiliation(s)
- Marita Yaghi
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Lebanon
| | - Rola Jaafar
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Lebanon
| | - Mariam Kanso
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Lebanon
| | - Mohamed Khalife
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Lebanon
| | - Walid Faraj
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Lebanon.
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Shirota C, Murase N, Tanaka Y, Ogura Y, Nakatochi M, Kamei H, Kurata N, Hinoki A, Tainaka T, Sumida W, Yokota K, Makita S, Oshima K, Uchida H. Laparoscopic Kasai portoenterostomy is advantageous over open Kasai portoenterostomy in subsequent liver transplantation. Surg Endosc 2020; 34:3375-3381. [PMID: 31485932 DOI: 10.1007/s00464-019-07108-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Native liver survival after laparoscopic Kasai portoenterostomy (Lap-PE) for biliary atresia (BA) is controversial. We examined whether a jaundice-free native liver survival rate is comparable between conventional Kasai portoenterostomy (Open-PE) and Lap-PE. Then, the impact of the two types of PE on subsequent living-donor liver transplantation (LTx) was addressed in this study. METHODS The jaundice-free rate in 1- and 2-year-old patients who underwent Open-PE and Lap-PE from January 2006 to December 2017 was investigated. Additionally, perioperative data (duration from the start of surgery to the completion of hepatectomy and others) of patients aged 2 years or younger who underwent LTx after either Open-PE or Lap-PE from 2006 to 2017 were evaluated. RESULTS Thirty-one (67%) out of 46 Open-PE patients and 23 (77%) out of 30 Lap-PE patients showed native liver survival with jaundice-free status at 1 year of age (p = 0.384); 29 (63%) out of 46 Open-PE patients and 19 (70%) out of 27 Lap-PE patients showed native liver survival with jaundice-free status at 2 years of age (p = 0.524); there were no significant differences. Additionally, there were 37 LTx cases after PE within 2 years of birth, including 29 Open-PE and 8 Lap-PE cases. The patients in the Lap-PE group had fewer adhesions and significantly shorter durations of surgery up to the completion of the recipient's hepatectomy and durations of post-LTx hospital stay compared to the Open-PE group. There were no differences in blood loss or duration of stay in intensive care unit between the Lap-PE and Open-PE groups. CONCLUSIONS Jaundice-free native liver survival rate has been comparable between Open-PE and Lap-PE. Lap-PE resulted in fewer adhesions, contributing to better outcomes of subsequent LTx compared to Open-PE.
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Affiliation(s)
- Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan
| | - Naruhiko Murase
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan
| | - Yasuhiro Ogura
- Department of Transplant Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Nakatochi
- Division of Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hideya Kamei
- Department of Transplant Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiko Kurata
- Department of Transplant Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan
| | - Kazuo Oshima
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan.
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Chan KWE, Lee KH, Wong HYV, Tsui SYB, Mou JWC, Tam YHP. Comparison of Characteristics and Outcomes in Antenatally and Postnatally Detected Choledochal Cyst in Infants and Young Children in a Laparoscopic Surgery Center. J Laparoendosc Adv Surg Tech A 2020; 30:1237-1241. [PMID: 32716684 DOI: 10.1089/lap.2020.0433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of this study was to compare the characteristics and the outcome between infants and young children with antenatally (AN) and postnatally (PN) detected choledochal cyst (CC) in a laparoscopic surgery center. Methods: A retrospective review was conducted for all children who underwent excision of CC and hepaticojejunostomy (HJ) before 36 months of age between October 2004 and October 2019. Results: Thirty-nine children (28 girls and 11 boys) were included in this study. Twenty-one children had AN detected CC and 18 had PN detected CC. The median age at operation (AN vs. PN; 3 months vs. 15.5 months, P < .001) and body weight (AN vs. PN; 5.6 kg vs. 10.5 kg, P < .001) were significantly different between the two groups. Children in PN group has an increased risk of being symptomatic (AN vs. PN; 6 vs. 18, P < .001) and having intervention before operation (AN vs. PN; 0 vs. 4, P = .037). Laparoscopic excision was performed in all children in AN group and in 12 children (66.7%) in PN group (P = .006). Conversion to open HJ was performed in 4 children in AN group but none in PN group (P = .146). There was no statistical differences in success in laparoscopic operation (P = .257), median operative time (P = .094), postoperative complication (P = .576), and median length of hospital stay (P = .749). Conclusions: Despite younger age at operation, the outcome of laparoscopic excision of AN detected CC was comparable with PN detected CC. Earlier detection and operation decreased the risk of preoperative intervention.
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Affiliation(s)
- Kin Wai Edwin Chan
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kim Hung Lee
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Hei Yi Vicky Wong
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Siu Yan Bess Tsui
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jennifer Wai Cheung Mou
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuk Him Peter Tam
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Yeung F, Fung ACH, Chung PHY, Wong KKY. Short-term and long-term outcomes after Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy following laparoscopic excision of choledochal cyst in children. Surg Endosc 2019; 34:2172-2177. [DOI: 10.1007/s00464-019-07004-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/19/2019] [Indexed: 02/08/2023]
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Leombroni M, Buca D, Celentano C, Liberati M, Bascietto F, Gustapane S, Marrone L, Manzoli L, Rizzo G, D'Antonio F. Outcomes associated with fetal hepatobiliary cysts: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:167-174. [PMID: 27553859 DOI: 10.1002/uog.17244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/09/2016] [Accepted: 08/15/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the outcomes associated with fetal hepatobiliary cysts. METHODS MEDLINE and EMBASE were searched for studies reporting on outcomes of fetal hepatobiliary cysts. Outcomes observed were resolution/reduction and increase in cyst size, associated congenital anomalies of the biliary tract and liver, abnormal postnatal liver function tests, clinical symptoms, need for surgery, postsurgical complications and predictive accuracy of prenatal ultrasound in identifying correctly hepatobiliary cysts. Meta-analysis of proportions was used to analyze the data. RESULTS The search identified 1498 articles, and 22 studies (252 fetuses) were included in the systematic review. For fetal hepatic cysts, resolution or reduction in cyst size either pre- or postnatally occurred in 59.3% (95% CI, 30.9-84.7%) of cases, while an increase in cyst size occurred in 8.7% (95% CI, 1.1-22.4%). No case of hepatic cyst had associated malformations of the biliary tract at birth. Clinical symptoms occurred in 14.8% (95% CI, 6.3-26.1%) of cases and, in 5.4% (95% CI, 0.9-13.6%), they were related to the presence of bile obstruction due to compression of the cyst on the biliary tract. No case of hepatic cyst had abnormal liver function at birth. For fetal biliary cysts, resolution or reduction in cyst size occurred in 8.7% (95% CI, 2.7-17.5%) of cases and an increase in size occurred in 34.4% (95% CI, 20.5-49.8%). Congenital anomalies of the biliary tract and liver, such as fibrosis, occurred in 21.5% (95% CI, 10.2-35.6%) and 17.4% (95% CI, 5.4-34.4%) of cases, respectively. 57.3% (95% CI, 33.9-79.0%) of cases showed impairment in liver function after birth, while 55.0% (95% CI, 37.5-71.9%) showed clinical symptoms, mainly due to bile obstruction (47.9% (95% CI, 29.4-66.7%)). Postsurgical complications occurred in 10.9% (95% CI, 3.7-21.3%) of operated cases. Risk assessment according to different cut-offs of cyst size could not be performed in view of the very small number of included studies. CONCLUSIONS Fetal hepatic cysts are benign, with a low likelihood of associated anomalies of the hepatobiliary tract, abnormal liver function or clinical symptoms. Congenital biliary cysts are associated with a high rate of progression, abnormal liver function after birth and clinical symptoms. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Leombroni
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - D Buca
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - C Celentano
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - M Liberati
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - F Bascietto
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - S Gustapane
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - L Marrone
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - L Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy
| | - G Rizzo
- Department of Obstetrics and Gynaecology, University of Rome, Rome, Italy
| | - F D'Antonio
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
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Soares KC, Goldstein SD, Ghaseb MA, Kamel I, Hackam DJ, Pawlik TM. Pediatric choledochal cysts: diagnosis and current management. Pediatr Surg Int 2017; 33:637-650. [PMID: 28364277 DOI: 10.1007/s00383-017-4083-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 02/07/2023]
Abstract
Choledochal cysts are rare congenital disorders first described by Vater and Ezler in 1723. Their exact etiology remains incompletely understood; however, an anomalous pancreaticobiliary union (APBDU) and subsequent reflux of biliary contents into the biliary tree are thought to play a role. Accordingly, APBDU-associated choledochal cyst patients are significantly more likely to have evidence of hepatitis, cholangitis or pancreatitis and pathologically confirmed inflammation. In 1977, Todani and colleagues modified the original Alonso-Lej classification to include five types of CC. Type I and IV are the most common and most likely to be associated with malignancy. The majority of choledochal cysts are diagnosed in childhood. Clinical presentation varies and most often consists of nonspecific abdominal pain. Diagnosis is typically accomplished using multimodality imaging techniques including computed tomography, magnetic resonance imaging, ultrasound and MRCP. The use of diagnostic PTC and ERCP in CC has been largely replaced by MRCP. Appropriate management consists of prompt, complete cyst excision followed by restoration of biliary enteric continuity when necessary. Minimally invasive CC resection in the pediatric population has demonstrated acceptable outcomes. Prognosis is generally excellent; however, malignancy risk remains higher than the general population even after complete surgical excision.
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Affiliation(s)
- Kevin C Soares
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Blalock 688, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Seth D Goldstein
- Division of General Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mounes A Ghaseb
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab Kamel
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David J Hackam
- Division of General Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Department of Surgery, Wexner Medical Center, Ohio State University, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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Chan KWE, Lee KH, Tsui SYB, Mou JWC, Tam YHP. Laparoscopic management of antenatally detected choledochal cyst: a 10-year review. Surg Endosc 2016; 30:5494-5499. [PMID: 27129540 DOI: 10.1007/s00464-016-4912-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/02/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this review was to study the characteristics and the outcome of children who underwent laparoscopic management of the antenatally detected choledochal cyst. METHODS A retrospective review was conducted for all children who underwent excision of antenatally detected choledochal cyst and hepaticojejunostomy from 2005 to 2015. RESULTS Fourteen patients (11 females and 3 males) were included in this study. The mean diameter of the cyst was 5.0 cm (range 2-12 cm). The mean age at operation was 3.5 months (range 11 days to 9 months). The mean body weight was 6.0 kg (range 3.9-10.0 kg). Five patients were symptomatic before operation. Laparoscopic excision of choledochal cyst was successful in all cases. The distal end of common bile duct (CBD) was cauterized in all but two cases. Conversion to open hepaticojejunostomy was required in two children. There was no intraoperative complication. Two patients had postoperative fever. One patient had minor bile leak that resolved on conservative management. The mean operative time was 286 min (range 200-390 min). The median hospital stay was 8 days (range 6-25 days). At a median follow-up of 46 months (range 6-118 months), all patients were freed from cholangitis or intestinal obstruction. Symptomatic patients had earlier operation (mean, 1.7 vs. 4.5 months p = 0.012) and were associated with postnatal increase in cyst size (p = 0.023) but were not associated with increased risk of complication or conversion (p = 1.000). CONCLUSIONS Laparoscopic excision of choledochal cyst and hepaticojejunostomy could be safety performed in patients with the cyst detected antenatally. The distal CBD was usually small and stenotic. Symptomatic patients had earlier operation with no increase in morbidity.
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Affiliation(s)
- Kin Wai Edwin Chan
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Kim Hung Lee
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siu Yan Bess Tsui
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jennifer Wai Cheung Mou
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuk Him Peter Tam
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Totally laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for choledochal cyst in adults: a single-institute experience of 5 years. Surg Laparosc Endosc Percutan Tech 2016; 25:e65-8. [PMID: 25122485 DOI: 10.1097/sle.0000000000000091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE The present study aimed to describe the authors' experience and the intermediate-term outcome for totally laparoscopic choledochal cyst excision and Roux-en-Y hepatoenterostomy at a single center in a 5-year period. METHODS We retrospectively analyzed the clinical data of totally laparoscopic choledochal cyst excision and Roux-en-Y hepatoenterostomy on 31 adult patients from January 2009 to November 2013. RESULTS Thirty-one cases successfully underwent totally laparoscopic choledochal cyst excision laparoscopy and Roux-en-Y hepatoenterostomy. The operation time varied from 200 to 360 minutes. The intraoperative blood loss was 50 to 210 mL. The patients passed flatus in 3.0 ± 1.3 days. The mean time interval to resume oral intake from the time of surgery was 3.8 ± 1.4 days. The duration of postoperative intravenous fluids was 4 to 11 days. Postoperative ambulation varied from 2 to 4 days. The duration of hospital stay was 4 to 13 days. Follow-up observations lasted 3 to 59 months and complications were noted in 4 patients. Of these patients, 1 patient suffered postoperative respiratory tract infection, 1 patient had an episode of adhesive small bowel obstruction, biliary leakage occurred in 1 patient, and 1 patient developed an anastomotic stoma stricture and cholangitis. There were no perioperative deaths. CONCLUSIONS Totally laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy is a safe, efficacious, and minimally invasive procedure for the most instances of adult choledochal cyst. The key of success is skilled laparoscopic skills, good team cooperation, and stapler anastomosis.
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Ng JL, Salim MT, Low Y. Mid-term Outcomes of Laparoscopic Versus Open Choledochal Cyst Excision in a Tertiary Paediatric Hospital. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2014. [DOI: 10.47102/annals-acadmedsg.v43n4p220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Paediatric laparoscopic choledochal cyst excision has increasingly gained acceptance as an alternative to open excision. Laparoscopic excision is feasible and safe in the short term, but long-term outcomes are not as well established. KK Women’s and Children’s Hospital started performing laparoscopic choledochal cyst excision in children since 2007. In this paper, we report our experience with the laparoscopic approach, and the early and mid-term outcomes in comparison with the conventional open approach. Materials and Methods: Thirty-five consecutive cases by a single surgeon between May 2006 and April 2012 were retrospectively reviewed. Patient characteristics and surgical outcomes were analysed. Results: There were 13 laparoscopic and 22 open cases. Baseline patient characteristics were similar. Operative time was longer in the laparoscopic group. Three cases in the laparoscopic group were converted to open in our early experience. There were no differences in time to feeds or length of hospitalisation. One laparoscopic case developed minor bile leak that resolved on conservative management. There were no complications in the laparoscopic group on median follow-up of 35 months. In the open group, there was 1 case of pancreatitis, cholangitis, and hypertrophic scarring respectively. There were 3 cases of suspected adhesive colic that resolved without surgery. Conclusion: Laparoscopic choledochal cyst excision enjoys excellent early and mid-term outcomes compared to open excision, even in centres with smaller patient volume. It should be the approach of choice where technical expertise is available.
Key words: Hepaticojejunostomy, Minimally invasive, Postoperative outcomes
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Affiliation(s)
- Jia Lin Ng
- KK Women’s and Children’s Hospital, Singapore
| | | | - Yee Low
- KK Women’s and Children’s Hospital, Singapore
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Cherqaoui A, Haddad M, Roman C, Gorincour G, Marti JY, Bonnard A, Guys JM, de Lagausie P. Management of choledochal cyst: Evolution with antenatal diagnosis and laparoscopic approach. J Minim Access Surg 2012; 8:129-33. [PMID: 23248439 PMCID: PMC3523449 DOI: 10.4103/0972-9941.103113] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 07/11/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIM: Laparoscopic excision of a choledochal cyst (CC) with hepaticojejunostomy gained a wide acceptance in the treatment of children even in neonatal period. Although, the use of prenatal diagnostic techniques causes a significant increase in antenatal diagnosis of CC, the time of surgical intervention during infancy is still controversial. A retrospective study was performed to evaluate the results of laparoscopic management of CC with special emphasis on antenatal diagnosis and treatment, and to compare the results with open procedure. MATERIALS AND METHODS: The patients who were diagnosed with choledochal cyst and underwent either open or laparoscopic hepaticojejunostomy in two centres, hopital d’enfant de La Timone from Marseille and hopital Robert Debre from Paris between November 2000 and December 2009 were included in the study. The data obtained from medical reports were evaluated for sex, time of antenatal diagnosis, age at time of operation, operative time, time of postoperation. RESULTS: A total of 19 hepaticojejunostomy were performed, including 10 open procedures (group A), and 9 laparoscopic procedures (group B, 4 were diagnosed prenatally, without conversion to open procedure). There were 3 boys and 16 girls, ranging in age from 2 weeks to 16 years. Patients in the group A were older than patients in the group B. The mean hospital stay and time to return of bowel fuction was longer in the group B. there were 60% of pre-operative complications in group A versus 22% in group B. There was one postoperative complications in group B (biliary leakage nedeed redo surgery). No significant differences were found between different parameters except for operative time (288.56 min in the group B versus 206 min in the group A. (p = 0.041)). CONCLUSIONS: Our initial experience indicates that the laparoscopic approach in infancy is technically feasible, safe, and effective, with a low morbidity and a comparable outcome to the open approach. Therefore, we propose a laparoscopic approach for antenatally diagnosed CC as early as possible, before the onset of complications.
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Affiliation(s)
- Abdelmounim Cherqaoui
- Department of Pediatric Surgery, Hopital d'enfants de la Timone, Marseille 13385, France
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Jang JY, Yoon YS, Kang MJ, Kwon W, Park JW, Chang YR, Ahn YJ, Cho JY, Han HS, Kim SW. Laparoscopic excision of a choledochal cyst in 82 consecutive patients. Surg Endosc 2012; 27:1648-52. [PMID: 23239299 DOI: 10.1007/s00464-012-2646-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 09/29/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite it being a benign disease, a choledochal cyst must be removed with the gallbladder (GB) due to the risk of cancer in the biliary tract. Most patients are young females or children, all of whom express strong interest in the cosmetic results in addition to the complete resolution of their medical problems. Here, we introduce a laparoscopic management technique for a choledochal cyst. METHODS Between 2003 and 2011, we performed a laparoscopic choledochal cyst excision procedure on 82 patients using a four-hole method. There were three open-conversion cases, one case involving robotic surgery, and one case involving combined laparoscopic liver resection because the cyst had affected the liver. Excision of the cyst and anastomosis were performed laparoscopically. We will present our method with a video. RESULTS The mean operation time was 230 min. The estimated blood loss was 197 ml. The average hospital stay was 8.6 days. The most common complications were minor bile leakage (7 %) and fluid collection (2.5 %), both of which were managed conservatively. CONCLUSIONS Laparoscopic management can be a treatment of choice for the most instances of choledochal cyst considering its good cosmetic results and its feasible level of operative safety.
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Affiliation(s)
- Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea.
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12
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Oberbauchschmerzen bei einer Jugendlichen. Monatsschr Kinderheilkd 2012. [DOI: 10.1007/s00112-012-2719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Liem NT, Pham HD, Dung LA, Son TN, Vu HM. Early and Intermediate Outcomes of Laparoscopic Surgery for Choledochal Cysts with 400 Patients. J Laparoendosc Adv Surg Tech A 2012; 22:599-603. [DOI: 10.1089/lap.2012.0018] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Nguyen Thanh Liem
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Hien Duy Pham
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Le Anh Dung
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Tran Ngoc Son
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Hoan Manh Vu
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
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14
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Hwang DW, Lee JH, Lee SY, Song DK, Hwang JW, Park KM, Lee YJ. Early experience of laparoscopic complete en bloc excision for choledochal cysts in adults. Surg Endosc 2012; 26:3324-9. [PMID: 22549376 DOI: 10.1007/s00464-012-2299-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 04/04/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND For choledochal cyst, the treatment of choice is total excision of the cyst because there is a risk of biliary cancer including the gallbladder. The current report describes the authors' early experiences using their technique of laparoscopic en bloc excision of choledochal cysts with Roux-en-Y biliary reconstruction. METHODS Between September 2009 and July 2011, laparoscopic excision for choledochal cyst was attempted for 20 patients at the Division of Hepatobiliary and Pancreatic Surgery, Asan Medical Center. Clinical, radiologic, and surgical data were analyzed retrospectively. RESULTS The mean age of the patients was 37.8 ± 11.1 years (range, 18-65 years), and the male-to-female ratio was 1:4.0 (4:16). According to Todani's classification, there were four type 1a cases, seven type 1c cases, and nine type 4a cases. The mean operation time was 395.8 ± 58.7 min. No perioperative transfusions were required. The average body mass index was 23.5 ± 4.04 kg/m(2). Conversion to laparotomy was required for seven patients (35 %) due to bleeding (n = 1), Roux loop venous congestion (n = 1), abdominal obesity (n = 2), and severe fibrosis and inflammation around the cyst (n = 3). No malignancies were identified. Of the 13 patients who underwent laparoscopy, the jejunojejunostomy was created extracorporeally for the first 2 patients and intracorporeally for the subsequent 11 patients. All hepaticojejunostomies were performed intracorporeally. Oral feeding was resumed on postoperative day 3. The mean postoperative hospital stay was 9.3 days (range, 8-36 days). No major complications or mortalities occurred. CONCLUSIONS The morbidity and mortality rates for the authors' method are comparable with previously reported results. Although the conversion rate, mean operation time, and hospital stay were greater than reported in some studies, this probably reflected the authors' learning curve for this technically challenging procedure. They believe laparoscopic approaches will eventually become an advantageous treatment option for laparotomy offered to selected choledochal cyst patients.
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Affiliation(s)
- Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea.
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15
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Diao M, Li L, Cheng W. Is it necessary to ligate distal common bile duct stumps after excising choledochal cysts? Pediatr Surg Int 2011; 27:829-32. [PMID: 21431961 DOI: 10.1007/s00383-011-2877-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE After excision of choledochal cysts (CDC), the distal common bile duct (CBD) stumps are conventionally ligated. Yet, the distal common bile duct stump mobilization and ligation carries certain risk of pancreatic duct injury. The current study investigates the feasibility of selectively leaving distal stump unligated in CDC children with stenotic distal CBD. METHODS Between 2001 and 2010, 270 CDC children successfully underwent laparoscopic cyst excision and Roux-en-Y hepatojejunostomy and were recruited into this study. The distal stump management was based on its radiological morphology. The patients were divided into two groups: (1) non-ligation group (n = 207), where the distal stump was stenotic and was left unligated; (2) ligation group (n = 63), where the distal stump was not stenotic and was ligated. The pancreatic juice leakage rates were compared. RESULTS The median follow-up periods in the non-ligation and ligation group were 36 and 33 months, respectively. There was no pancreatic juice leakage in either group. CONCLUSION Not ligating distal stump is a feasible approach for managing CDC with stenotic distal CBD. It simplifies the operative procedure and may minimize pancreatic duct injury.
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Affiliation(s)
- Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
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16
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Liem NT, Pham HD, Vu HM. Is the Laparoscopic Operation as Safe as Open Operation for Choledochal Cyst in Children? J Laparoendosc Adv Surg Tech A 2011; 21:367-70. [DOI: 10.1089/lap.2010.0375] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Nguyen T. Liem
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Hien D. Pham
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Hoan M. Vu
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
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17
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Urushihara N, Fukuzawa H, Fukumoto K, Sugiyama A, Nagae H, Watanabe K, Mitsunaga M, Miyake H. Totally laparoscopic management of choledochal cyst: Roux-en-Y Jejunojejunostomy and wide hepaticojejunostomy with hilar ductoplasty. J Laparoendosc Adv Surg Tech A 2011; 21:361-6. [PMID: 21486149 DOI: 10.1089/lap.2010.0373] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cyst excision with hepaticojejunostomy is the treatment of choice for choledochal cyst. However, late complications after definitive surgery develop occasionally, including intrahepatic stones and cholangitis, because of bile stasis resulting from anastomotic stricture, intrahepatic bile duct stricture, and remnants of intrahepatic ductal dilatation. In type IV-A choledochal cysts in particular, biliary stricture is frequently observed around the hepatic hilum, and ductoplasty for stricture is necessary. In this article, we present our experiences with totally laparoscopic surgery comprising excision of the extrahepatic bile duct, Roux-en-Y jejunojejunostomy, and wide hepaticojejunostomy combined with hilar ductoplasty for choledochal cyst. METHODS We performed totally laparoscopic surgery on 8 children with choledochal cyst between June 2009 and October 2010. One of them had undergone bile drainage through gallbladder laparoscopically for biliary perforation. Four patients (1 Ic and 3 IV-A cysts) had hepatic duct stricture around the hepatic hilum. Laparoscopic surgery comprising excision of the extrahepatic bile duct and wide Roux-en-Y hepaticojejunostomy with ductoplasty was performed by using four trocars. RESULTS The operation was completed laparoscopically for all patients. The mean operation time was 390 minutes (range, 310-460). The mean postoperative stay was 8.4 days (range, 7-14). After surgery, the dilatation of the intrahepatic bile duct was remarkably reduced in size, and all patients are doing well. CONCLUSION Laparoscopic surgery comprising excision of the extrahepatic bile duct, Roux-en-Y limb formation, and wide hepaticojejunostomy with hilar ductoplasty appears to be feasible for children with choledochal cyst. When there is a stricture near the confluence of the hepatic ducts, laparoscopic ductoplasty appears to be feasible for the surgeon with an advanced laparoscopic skill set.
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Affiliation(s)
- Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
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Gander JW, Cowles RA, Gross ER, Reichstein AR, Chin A, Zitsman JL, Middlesworth W, Rothenberg SS. Laparoscopic excision of choledochal cysts with total intracorporeal reconstruction. J Laparoendosc Adv Surg Tech A 2010; 20:877-81. [PMID: 20879872 DOI: 10.1089/lap.2010.0123] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE There are numerous published reports of laparoscopic resection of choledochal cysts (CDCs), but almost all involve extracorporeal reconstruction of a biliary drainage system. We describe and evaluate the technique of laparoscopic CDC resection with total intracorporeal reconstruction. METHODS We reviewed all patients who underwent a laparoscopic CDC resection from March 2005 to January 2010 at Rocky Mountain Children's Hospital and Children's Hospital of New York-Presbyterian. We obtained data on operative time, characteristics of reconstruction, time to initiation of diet, length of stay, complications, and outcome. RESULTS Thirteen patients (median age 5 years, range 1-16) underwent a laparoscopic CDC excision with total intracorporeal reconstruction. Four ports were used in all cases and no patients required conversion to an open procedure. Operative time ranged from 130 to 325 minutes (median 240 minutes). Median time to initiation of diet was 1 day (range 1-4 days). Median length of stay was 5 days (range 4-8 days). There were no cases of cholangitis; however, 1 patient developed a small bowel obstruction requiring re-operation. CONCLUSION Laparoscopic resection of CDCs with total intracorporeal reconstruction is a safe and effective technique. The minimal handling of the bowel appears to minimize postoperative ileus, allows for early postoperative feeding and discharge.
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Affiliation(s)
- Jeffrey W Gander
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York, USA
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Nguyen Thanh L, Hien PD, Dung LA, Son TN. Laparoscopic repair for choledochal cyst: lessons learned from 190 cases. J Pediatr Surg 2010; 45:540-4. [PMID: 20223317 DOI: 10.1016/j.jpedsurg.2009.08.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 08/10/2009] [Accepted: 08/10/2009] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study is to report the technical details, early outcomes, and lessons learned from laparoscopic repair of 190 cases of choledochal cyst. METHOD The operation was performed using 4 ports. The cystic duct was identified and divided. The liver was elevated by 2 stay-sutures: one on the round ligament and the other on the distal cystic duct. The choledochal cyst was isolated and removed completely, and then biliary-digestive continuity was reestablished. RESULTS From January 2007 to April 2009, 190 patients were operated on. There were 144 girls and 46 boys. Ages ranged from 2 months to 16 years (mean, 46.9 +/- 29.3 months). Cyst diameter ranged from 10 to 184 mm. A total of 106 patients were classified as Todani type I cysts, and 84 were type IV. Cystic excision and hepaticoduodenostomy were performed in 133 patients and hepaticojejunostomy in 57 patients. The operating time varied from 70 to 505 minutes (mean, 186 minutes). Conversion to open surgery was required in 2 patients. Intraoperative blood transfusion was required in 4 patients. There were no perioperative deaths. Postoperative anastomotic leakage occurred in 7 patients, resolving spontaneously in 6 and requiring a second operation in 1. Postoperative hospital stay ranged from 5 to 27 days (mean, 7.2 +/- 3.3 days). Follow-up occurred between 1 and 24 months postdischarge (mean, 9 +/- 2.2 months) and was obtained in 161 patients (84.7%). Of these patients, cholangitis occurred in 4 patients (2.4%). CONCLUSION Laparoscopic repair is a safe and effective procedure for choledochal cyst.
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Affiliation(s)
- Liem Nguyen Thanh
- Department of Surgery, National Hospital of Pediatrics, Dong Da District, Hanoi, Vietnam.
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Ahn SM, Jun JY, Lee WJ, Oh JT, Han SJ, Choi SH, Hwang EH. Laparoscopic Total Intracorporeal Correction of Choledochal Cyst in Pediatric Population. J Laparoendosc Adv Surg Tech A 2009; 19:683-6. [DOI: 10.1089/lap.2008.0116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Soo Min Ahn
- Division of Pediatric Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | | | - Woo Jung Lee
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Tak Oh
- Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Joo Han
- Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hoon Choi
- Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui Ho Hwang
- Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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21
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Martino A, Noviello C, Cobellis G, Mastroianni L. Delayed Upper Gastrointestinal Bleeding After Laparoscopic Treatment of Forme Fruste Choledochal Cyst. J Laparoendosc Adv Surg Tech A 2009; 19:457-459. [DOI: 10.1089/lap.2008.0290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ascanio Martino
- Pediatric Surgery Unit, Academic Children's Hospital “Salesi,” Ancona, Italy
| | - Carmine Noviello
- Pediatric Surgery Unit, Academic Children's Hospital “Salesi,” Ancona, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Academic Children's Hospital “Salesi,” Ancona, Italy
| | - Luciano Mastroianni
- Pediatric Surgery Unit, Academic Children's Hospital “Salesi,” Ancona, Italy
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22
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Chokshi NK, Guner YS, Aranda A, Petrosyan M, Shin CE, Ford HR, Nguyen NX. Laparoscopic Choledochal Cyst Excision: Lessons Learned in Our Experience. J Laparoendosc Adv Surg Tech A 2009; 19:87-91. [DOI: 10.1089/lap.2008.0045] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Nikunj K. Chokshi
- Department of Pediatric Surgery, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Yigit S. Guner
- Department of Pediatric Surgery, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Arturo Aranda
- Department of Pediatric Surgery, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mikael Petrosyan
- Department of Pediatric Surgery, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cathy E. Shin
- Department of Pediatric Surgery, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Henri R. Ford
- Department of Pediatric Surgery, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nam X. Nguyen
- Department of Pediatric Surgery, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
- Long Beach Memorial Medical Center, Children's Hospital, Long Beach, California
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Laparoscopic management of choledochal cysts: technique and outcomes--a retrospective study of 35 patients from a tertiary center. J Am Coll Surg 2008; 207:839-46. [PMID: 19183529 DOI: 10.1016/j.jamcollsurg.2008.08.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 07/22/2008] [Accepted: 08/04/2008] [Indexed: 01/27/2023]
Abstract
BACKGROUND Choledochal cysts are congenital dilations of the biliary tree. The accepted mode of treatment is total excision with hepaticojejunostomy. In this retrospective study, we present our technique and results of laparoscopic choledochal cyst excision. STUDY DESIGN We retrospectively studied 35 patients who had undergone laparoscopic choledochal cyst excision in our institute from 1996 to 2008. Data about age, gender, type of choledochal cyst, symptoms, surgical technique, conversion rate, morbidity, and mortality were analyzed. RESULTS There were Type 1B choledochal cysts in 27 patients (77%) and Type IVA in 8 patients (23%). An anomalous pancreatobiliary junction was found in 40%. Mean operative time was 295 minutes. Total cyst excision could be done in 26 patients. The conversion rate in our series was 8.5%. The overall morbidity rate was 14.3%, the reoperation rate was 8.5%, the mortality rate was 0%, and the incidence of carcinoma was 8.5%. CONCLUSIONS To minimize the risk of malignancy, total excision of the cyst is ideal, but a small proximal cuff of cyst is retained for small-size ducts to aid in the hepaticojejunostomy anastomosis. A slit on one end of the small ducts will render the anastomosis in an oblique orientation, widening the lumen. Dissecting the posterior cyst wall from the underlying portal vein is the most crucial part of the procedure. Morbidity and mortality rates after laparoscopic management are comparable with published results of the open procedure. Laparoscopic surgery for choledochal cysts is feasible, safe, and even advantageous.
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Meehan JJ, Elliott S, Sandler A. The robotic approach to complex hepatobiliary anomalies in children: preliminary report. J Pediatr Surg 2007; 42:2110-4. [PMID: 18082719 DOI: 10.1016/j.jpedsurg.2007.08.040] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 08/08/2007] [Indexed: 02/08/2023]
Abstract
PURPOSE Robotic technology allows surgeons to perform complex procedures which may be difficult with standard laparoscopic instruments. We believe that complex hepatobiliary procedures are ideally suited for robotic surgery in children and present our experience with Kasai portoenterostomy and excision of choledochal cysts. METHODS We performed 4 complex hepatobiliary procedures in children using the Da Vinci surgical robot (Intuitive Surgical, Sunnyvale, CA): 2 Kasai portoenterostomies and 2 choledochal cyst resections. Both Kasais had the Roux-en-Y jejunojejunostomy performed extracorporeally through the 12 mm umbilical trocar site. Both choledochal cysts had the Roux-En-Y jejunojejunostomy performed intracorporeally. All patients had their hepatobiliary to enteric anastomosis performed intracorporeally. RESULTS Total average time was 6 hours and 12 minutes for the Kasai and 7 hours and 38 minutes for the choledochal cysts. The average robotic console time for all cases was 6 hours. No intraoperative or perioperative complications occurred. Average length of hospital stay was 4 days. Both choledochal cyst patients were doing well after 9 and 12 months with no complications. One Kasai patient is doing well 14 months after Kasai with a normal bilirubin. The other Kasai patient did well for a year with a normal bilirubin. However, the patient slowly developed intrahepatic bile lakes despite a normal bilirubin and a well draining Kasai as demonstrated by hepatobiliary iminodiacetic acid (HDA) scan. He began having recurrent episodes of cholangitis and we referred him for liver transplantation. CONCLUSION Minimally invasive robotic complex hepatobiliary surgery is safe and effective in children. The 3-dimensional imaging and improved articulations make these procedures particularly suited for robotics over standard laparoscopy.
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Affiliation(s)
- John J Meehan
- Division of Pediatric Surgery, Seattle Children's Hospital and Regional Medical Center, Seattle, WA 98105, USA.
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Abbas HMH, Yassin NA, Ammori BJ. Laparoscopic Resection of Type I Choledochal Cyst in an Adult and Roux-en-Y Hepaticojejunostomy: A Case Report and Literature Review. Surg Laparosc Endosc Percutan Tech 2006; 16:439-44. [PMID: 17277665 DOI: 10.1097/01.sle.0000213768.70923.99] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Choledochal cysts are rare cystic dilatations of the extrahepatic biliary tree, the intrahepatic bile ducts, or both and carry a substantial risk of malignant transformation. Type I choledochal cysts, which involve the entire common hepatic and common bile ducts, represent 80% to 90% of these lesions. We report laparoscopic excision of symptomatic type I choledochal cyst in a 37-year-old woman, and review the literature. Laparoscopic excision of the extrahepatic biliary tree from the hepatic confluence to the anomalous pancreatobiliary junction with en bloc cholecystectomy and reconstruction with a Roux-en-Y hepaticojejunostomy was accomplished. Postoperative recovery was uneventful with a hospital stay of 3 days. She remains well and asymptomatic at 6 months of follow-up. Laparoscopic excision of choledochal cysts may be safely accomplished with a prompt recovery. Further experience with this approach in larger number of patients is justified and long-term follow-up data are needed.
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Affiliation(s)
- Hasan M H Abbas
- Department of Surgery, Manchester Royal Infirmary, Manchester, UK
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