Advertisement

Surgical Endoscopy

, Volume 30, Issue 12, pp 5513–5519 | Cite as

Laparoscopic redo hepaticojejunostomy for children with choledochal cysts

  • Mei Diao
  • Long Li
  • Wei Cheng
Article

Abstract

Background

The current study is to evaluate the long-term efficacy of laparoscopic redo hepaticojejunostomy (LRH) for children with cholecochal cysts (CDCs).

Methods

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.

Results

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.

Conclusions

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.

Keywords

Choledochal cysts Laparoscopic redo surgery Postoperative biliary obstruction Hepaticojejunostomy Children 

Notes

Disclosures

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

References

  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.
    Bowers SP, Hunter JG (2006) Contraindications to laparoscopy the SAGE manual: perioperative care in minimal invasive surgery. Springer, New YorkGoogle Scholar
  5. 5.
    Li L, Feng W, Jing-Bo F, Qi-Zhi Y, Gang L, Liu-Ming H, Yu L, Jun J, Ping W (2004) Laparoscopic-assisted total cyst excision of choledochal cyst and Roux-en-Y hepatoenterostomy. J Pediatr Surg 39:1663–1666CrossRefPubMedGoogle Scholar
  6. 6.
    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
  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 (2015) Recurrence of biliary tract obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cysts. Surg Endosc. doi: 10.1007/s00464-015-4697-5
  11. 11.
    Asensio M, Gander R, Royo GF, Lloret J (2015) Failed pyeloplasty in children: is robot-assisted laparoscopic reoperative repair feasible? J Pediatr Urol 11:69.e61–69.e66CrossRefGoogle Scholar
  12. 12.
    Diao M, Li L, Cheng W (2013) Role of laparoscopy in treatment of choledochal cysts in children. Pediatr Surg Int 29:317–326CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

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 HospitalBeijingPeople’s Republic of China

Personalised recommendations