Abstract
Background
The feasibility of laparoscopic resection of choledochal cyst and hepaticojejunostomy in children is still unclear. This report presents the author’s experience with a first series of patients.
Methods
Data from 11 consecutive children (median age 17.5 months, SD 22, range 2 to 70) with choledochal cyst scheduled for laparoscopy were collected prospectively. There were nine type I and 2 type V cysts according to Todani’s classification. All except one patient had intermittent jaundice or recurrent pancreatitis. The laparoscopic technique included excision of the cyst. A Roux-en-Y anastomosis was constructed after exteriorization of the small bowel via the infraumbilical trocar incision. After repositioning of the bowel an end-to-side hepaticojejunostomy was carried out laparoscopically.
Results
The procedures were carried out in nine children without intraoperative events and a median duration of 289 min (SD 62). In two patients, the operation was converted after 60 and 90 min due to a lack of overview at the dorsal margin with problems in separation of the portal vein. Oral food intake was started within 2 days and tolerated well in all except one patient, in whom biliar fluid from the drain led to laparoscopic reevaluation on day 1. A small leak was resutured and the patient was discharged on day 5. In one patient, recurrent cholangitis and a dilated Roux-en-Y loop led to correction of some kinking of the loop via laparotomy after 3 months. All other patients are well with bile-stained stools after a mean follow-up of 13 months.
Conclusions
Laparoscopic resection of congenital choledochal cyst and choledochojejunostomy in children is feasible. We feel that there is a considerable learning curve with the technique. Future studies will have to prove the feasibility of laparoscopic Roux-en-Y bowel anastomosis without the need for bowel exteriorization.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
G Belli G Rotondano A D’Agostino A Janelli J Marano ML Santangelo (1998) ArticleTitleCystic dilation of extrahepatic bile duct in childhood diagnosis and surgical treatment and long-term results HPB Surg 10 179–184
PK Chowbey MP Katrak A Sharma et al. (2002) ArticleTitleComplete laparoscopic management of choledochal cyst: report of two cases J Laparoendosc Adv Surg Tech A12 217–221 Occurrence Handle10.1089/10926420260188146
JS Vries ParticleDe S Vries ParticleDe DC Aronson et al. (2002) ArticleTitleCholedochal cysts: age of presentation, symptoms, and late complications related to Todani’s classification J Pediatr Surg 37 1568–1573 Occurrence Handle10.1053/jpsu.2002.36186 Occurrence Handle12407541
JJ Duron JM Hay S Msika et al. (2000) ArticleTitlePrevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery: a retrospective multicenter study. French Association for Surgical Research Arch Surg 135 208–212 Occurrence Handle10.1001/archsurg.135.2.208 Occurrence Handle10668883
GA Farello A Cerofolini M Rebonato et al. (1995) ArticleTitleCongenital choledochal cyst: video-guided laparoscopic treatment Surg Laparosc Endosc 5 354–358 Occurrence Handle8845978
S Fujisaki T Akiyama H Miyake et al. (1999) ArticleTitleA case of carcinoma associated with the remained intrapancreatic biliary tract 17 years after the primary excision of a choledochal cyst Hepatogastroenterology 27 1655–1659
M Koike K Yasui Y Shimizu et al. (2002) ArticleTitleCarcinoma of the hepatic hilus developing 21 years after biliary diversion for choledochal cyst: a case report Hepatogastroenterology. 49 1216–1220 Occurrence Handle12239908
H Lee S Hirose B Bratton D Farner (2004) ArticleTitleInitial experience with complex laparoscopic biliary surgery in children: biliary atresia and choledochal cyst J Pediatr Surg 39 804–807 Occurrence Handle10.1016/j.jpedsurg.2004.02.018 Occurrence Handle15185200
DC Liu JA Rodriguez F Meric JL Geiger (2000) ArticleTitleLaparoscopic excision of a rare type II choledochal cyst: case report and review of the literature J Pediatr Surg 35 1117–1119 Occurrence Handle10.1053/jpsu.2000.7840 Occurrence Handle10917310
M Niewenhuizen MM Reijnen JH Kuijpers H Goor Particlevan (1998) ArticleTitleSmall bowel obstruction after total or subtotal colectomy: a 10-year retrospective review Br J Surg 85 1242–1245 Occurrence Handle10.1046/j.1365-2168.1998.00841.x Occurrence Handle9752868
H Shimura M Tanaka S Shimizu K Mizumoto (1998) ArticleTitleLaparoscopic treatment of congenital choledochal cyst Surg Endosc 12 1268–1271 Occurrence Handle10.1007/s004649900834 Occurrence Handle9745070
MA Talamini (2001) ArticleTitleCommentary on “Laparoscopically assisted resection of choledochal cyst and Roux-en-Y reconstruction” Surg Endosc 15 522 Occurrence Handle10.1007/s004640080180
HL Tan KR Shankar WDA Ford (2003) ArticleTitleLaparoscopic resection of type I choledochal cyst Surg Endosc 17 1495 Occurrence Handle10.1007/s00464-003-4502-8
M Tanaka S Shimizu K Mizumoto et al. (2001) ArticleTitleLaparoscopically assisted resection of choledochal cyst and Roux-en-Y reconstruction Surg Endosc 15 545–551 Occurrence Handle10.1007/s004640000380 Occurrence Handle11591937
T Todani Y Watanabe M Narusue et al. (1977) ArticleTitleCongenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cysts Am J Surg 134 263–269 Occurrence Handle10.1016/0002-9610(77)90359-2 Occurrence Handle889044
BM Ure NM Bax DC Zee Particlevan der (2000) ArticleTitleLaparoscopy in infants and children: a prospective study on the feasibility and it’s impact on routine surgery J Pediatr Surg 35 1170–1173 Occurrence Handle10.1053/jpsu.2000.8720 Occurrence Handle10945688
Ure BM, Nustede R (2005) Laparoscopic resection of congenital choledochal cyst, choledochojejunostomy and Roux-en Y anastomosis. J Pediatr Surg
Y Watanabe M Sato K Tokui et al. (1999) ArticleTitleLaparoscope-assisted minimally invasive treatment for choledochal cyst J Laparoendosc Adv Surg Tech A 9 415–418 Occurrence Handle10522537
BM Wilkens L Spitz (1986) ArticleTitleIncidence of postoperative adhesion obstruction following neonatal laparotomy Br J Surg 73 762–764 Occurrence Handle3756446
A Yamataka H Kobayashi A Shimotakahara et al. (2003) ArticleTitleRecommendations for preventing complications to Roux-en-Y hepatico-jejunostomy performed during excision of choledochal cyst in children J Pediatr Surg 38 1830–1832 Occurrence Handle10.1016/j.jpedsurg.2003.08.027 Occurrence Handle14666479
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ure, B., Schier, F., Schmidt, A. et al. Laparoscopic Resection Of Congenital Choledochal Cyst, Choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis. Surg Endosc 19, 1055–1057 (2005). https://doi.org/10.1007/s00464-004-2191-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-004-2191-6