Surgical Endoscopy

, Volume 30, Issue 9, pp 3910–3915 | Cite as

Recurrence of biliary tract obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cysts

  • Mei Diao
  • Long Li
  • Wei Cheng



The aim of the current study was to investigate the cause and develop a management strategy for recurrent biliary obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cyst (CDC).


Thirty CDC patients (mean age: 7.15 years, range 8 months–24 years, F/M: 22/8) who suffered from recurrent biliary obstructions after primary laparoscopic hepaticojejunostomies were referred to our hospital between January 2006 and June 2014. All patients underwent redo hepaticojejunostomy ± ductoplasty ± reposition of aberrant right hepatic arteries.


All patients developed recurrent cholangitis or persistent abnormal liver function 1 month to 7 years postoperatively. Liver biopsy pathology verified that 56.7 % (17/30) of patients had grades I–IV of liver fibrosis. We identified a previously unreported cause of biliary obstruction, i.e., aberrant right hepatic arteries crossing anteriorly to the proximal common hepatic duct in high percentage of the patients who suffered from postoperative recurrent biliary obstructions (7/30, 23.3 %). The hepatic arteries were repositioned behind Roux loop during the redo hepaticojejunostomies. Of remaining patients, nine (30 %) patients had associated hepatic duct strictures and underwent ductoplasties and wide hepaticojejunostomies. Fourteen (46.7 %) patients had anastomotic strictures and underwent redo hepaticojejunostomies. The median follow-up period was 62 months (14–115 months). No recurrent biliary obstruction or cholangitis was observed up to date. Liver functions were normalized.


Aberrant hepatic artery, unsolved hepatic duct stricture, as well as poor anastomotic technique, can all contribute to recurrent biliary obstructions after the primary laparoscopic hepaticojejunostomies. Early surgical correction is advocated to minimize liver damage.


Choledochal cysts Laparoscopy Postoperative recurrent biliary obstruction Hepaticojejunostomy Children Aberrant hepatic artery 


Compliance with ethical standards


Dr. Mei Diao, Prof. Long Li, and Prof. Wei Cheng declare no conflicts of interest or financial ties to disclose.


  1. 1.
    Ono S, Fumino S, Shimadera S, Iwai N (2010) Long-term outcomes after hepaticojejunostomy for choledochal cyst: a 10- to 27-year follow-up. J Pediatr Surg 45:376–378CrossRefPubMedGoogle Scholar
  2. 2.
    Urushihara N, Fukumoto K, Fukuzawa H, Mitsunaga M, Watanabe K, Aoba T, Yamoto M, Miyake H (2012) Long-term outcomes after excision of choledochal cysts in a single institution: operative procedures and late complications. J Pediatr Surg 47:2169–2174CrossRefPubMedGoogle Scholar
  3. 3.
    Yamataka A, Ohshiro K, Okada Y, Hosoda Y, Fujiwara T, Kohno S, Sunagawa M, Futagawa S, Sakakibara N, Miyano T (1997) Complications after cyst excision with hepaticoenterostomy for choledochal cysts and their surgical management in children versus adults. J Pediatr Surg 32:1097–1102CrossRefPubMedGoogle Scholar
  4. 4.
    Michels N (1951) The hepatic, cystic and retroduodenal arteries and their relations to the biliary ducts. Ann Surg 133:503–524CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Tsuchiya R, Eto T, Harada N, Yamamoto K, Matsumoto T, Tsunoda T, Yamaguchi T, Noda T, Izawa K (1984) Compression of the common hepatic duct by the right hepatic artery in intrahepatic gallstones. World J Surg 8:321–326CrossRefPubMedGoogle Scholar
  6. 6.
    Agur AMR, Dalley AF II (2012) Abdomen-Biliary ducts. In: Agur AMR, Dalley AF II (eds) Grant’s atlas of anatomy, 13th edn. Lippincott Williams & Wilkins, Philadelphia, pp 160–164Google Scholar
  7. 7.
    Baek YH, Choi SR, Lee JH, Kim MJ, Kim YH, Roh YH, Roh MH (2008) Obstructive jaundice due to compression of the common bile duct by right hepatic artery originated from gastroduodenal artery. Korean J Gastroenterol 52:394–398PubMedGoogle Scholar
  8. 8.
    Todani T, Watanabe Y, Toki A, Ogura K, Wang ZQ (1998) Co-existing biliary anomalies and anatomical variants in choledochal cyst. Br J Surg 85:760–763CrossRefPubMedGoogle Scholar
  9. 9.
    Lal R, Behari A, Hari RH, Sikora SS, Yachha SK, Kapoor VK (2013) Variations in biliary ductal and hepatic vascular anatomy and their relevance to the surgical management of choledochal cysts. Pediatr Surg Int 29:777–786CrossRefPubMedGoogle Scholar
  10. 10.
    Diao M, Li L, Cheng W (2013) Role of laparoscopy in treatment of choledochal cysts in children. Pediatr Surg Int 29:317–326CrossRefPubMedGoogle Scholar
  11. 11.
    Nennstiel S, Weber A, Frick G, Haller B, Meining A, Schmid RM, Neu B (2015) Drainage-related complications in percutaneous transhepatic biliary drainage: an analysis over 10 years. J Clin Gastroenterol 49(9):764–770CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryCapital Institute of PediatricsBeijingPeople’s Republic of China
  2. 2.Department of Paediatrics and Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonAustralia
  3. 3.Department of SurgeryBeijing United Family HospitalBeijingChina

Personalised recommendations