Laparoscopic management of pediatric choledochal cysts in developing countries: review of ten cases
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We report laparoscopic management of choledochal cysts (CDC) in 10 children. We dissect the CDC using conventional mono- and bi-polar diathermy up to the lower end, ligate or clip it at the lowest possible level and divide it. The proximal end is divided after leaving a sufficient cuff for anastomosis. In the first three cases, we formally opened to complete the biliary-enteric anastomosis. However, in the subsequent seven cases, we made a small midline incision to develop a Roux-en Y loop, and the anastomosis was then completed by intra-corporeal suturing after re-creating the pneumo-peritoneum. Apart from biliary leak in one case, we did not encounter any major complications. The mean operative time was 4.2 h. We have discussed the technical points in the study. We conclude that CDC is eminently suitable for laparoscopic correction; it requires advanced skills and expertise for precise dissection and meticulous suturing in restricted spaces. If the case selection is good and if the team is experienced, CDC can be effectively managed using laparoscopy even without a sophisticated equipment. The wound- and scar-related morbidity is minimized.
KeywordsLaparoscopy Choledochal cyst (CDC) Minimally invasive surgery (MIS) Laparoscopic surgery
We acknowledge the following for their valuable contribution. The director of the institute for his permission to utilize the patient data for publication. The anesthetic team (Dr. Chandrika, Dr. C.R. Chandrashekara and Dr. Chandrakala) and the nursing staff for their excellent support during the operative procedures. Mr. B.S.Ravishankar, Dr. Narendra Babu and Dr. V.S. Kiran for their help in the preparation of the manuscript.
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