Laparoscopic redo hepaticojejunostomy for children with choledochal cysts
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The current study is to evaluate the long-term efficacy of laparoscopic redo hepaticojejunostomy (LRH) for children with cholecochal cysts (CDCs).
Between January 2006 and January 2016, 44 CDC children who had biliary re-obstructions after primary definitive surgeries successfully underwent LRH in our hospital. The hepatic arteries were repositioned behind Roux loop. Ductoplasties and wide hepaticojejunostomies were carried out. The operative time, postoperative recovery and complications were compared with our open redo hepaticojejunostomy (ORH, n = 16) between October 2001 and December 2005.
There was no significant difference of age at surgery between two groups. Mean operative time in the LRH group was 2.32 h, which did not differ from 2.05 h in the ORH group (p = 0.11). Average postoperative hospital stay, resumption of full diet and duration of drainage in the LRH group were 5.47, 2.11 and 3.22 days, respectively, significantly shorter than 7.37, 3.31 and 4.50 days in our ORH group (p < 0.001, respectively). Median follow-up period was 48 months (1–120 months) in the LRH group and 140 months (120–170 months) in the ORH group. No recurrent biliary obstruction, cholangitis, intrahepatic stone formation or carcinoma were detected in either group. No blood transfusion was required in the LRH group, while one patient in ORH group required 3-day hemostatic treatment and blood transfusion for postoperative bleeding. In the LRH group, one patient suffered from bile leak and spontaneously cured after 7-day drainage. Two patients in the ORH group developed wound dehiscence and required surgical repairs. Overall morbidities were 2.3 % (1/44) in LRH group and significantly <18.8 % (3/16) in ORH group (p < 0.05). Liver function parameters normalized in both groups.
In experienced hands, LRH does not necessarily require open surgery. Long-term results of the LRH group were comparable or even superior to those of the ORH group.
KeywordsCholedochal cysts Laparoscopic redo surgery Postoperative biliary obstruction Hepaticojejunostomy Children
Dr. Mei Diao, Prof. Long Li, and Prof. Wei Cheng declare no conflicts of interest or financial ties to disclose.
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