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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
Article

Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

Keywords

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

Notes

Compliance with ethical standards

Disclosures

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

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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

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