Abstract
Background
The aim of this review was to study the characteristics and the outcome of children who underwent laparoscopic management of the antenatally detected choledochal cyst.
Methods
A retrospective review was conducted for all children who underwent excision of antenatally detected choledochal cyst and hepaticojejunostomy from 2005 to 2015.
Results
Fourteen patients (11 females and 3 males) were included in this study. The mean diameter of the cyst was 5.0 cm (range 2–12 cm). The mean age at operation was 3.5 months (range 11 days to 9 months). The mean body weight was 6.0 kg (range 3.9–10.0 kg). Five patients were symptomatic before operation. Laparoscopic excision of choledochal cyst was successful in all cases. The distal end of common bile duct (CBD) was cauterized in all but two cases. Conversion to open hepaticojejunostomy was required in two children. There was no intraoperative complication. Two patients had postoperative fever. One patient had minor bile leak that resolved on conservative management. The mean operative time was 286 min (range 200–390 min). The median hospital stay was 8 days (range 6–25 days). At a median follow-up of 46 months (range 6–118 months), all patients were freed from cholangitis or intestinal obstruction. Symptomatic patients had earlier operation (mean, 1.7 vs. 4.5 months p = 0.012) and were associated with postnatal increase in cyst size (p = 0.023) but were not associated with increased risk of complication or conversion (p = 1.000).
Conclusions
Laparoscopic excision of choledochal cyst and hepaticojejunostomy could be safety performed in patients with the cyst detected antenatally. The distal CBD was usually small and stenotic. Symptomatic patients had earlier operation with no increase in morbidity.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lipsett PA, Pitt HA (2003) Surgical treatment of choledochal cysts. J Hepatobiliary Pancreat Surg 10(5):352–359
Lugo-Vicente HL (1995) Prenatally diagnosed choledochal cysts: Observation or early surgery? J Pediatr Surg 30(9):1288–1290
Mackenzie TC, Howell LJ, Flake AW, Adzick NS (2001) The management of prenatally diagnosed choledochal cysts. J Pediatr Surg 36(8):1241–1243
Okada T, Sasaki F, Ueki S, Hirokata G, Okuyama K, Cho K, Todo S (2004) Postnatal management for prenatally diagnosed choledochal cysts. J Pediatr Surg 39(7):1055–1058
Lee SC, Kim HY, Jung SE, Park KW, Kim WK (2006) Is excision of a choledochal cyst in the neonatal period necessary? J Pediatr Surg 41(12):1984–1986
Foo DC, Wong KK, Lan LC, Tam PK (2009) Impact of prenatal diagnosis on choledochal cysts and the benefits of early excision. J Paediatr Child Health 45(1–2):28–30
Farello GA, Cerofolini A, Rebonato M, Bergamaschi G, Ferrari C, Chiappetta A (1995) Congenital choledochal cyst: video-guided laparoscopic treatment. Surg Laparosc Endosc 5:354–358
Lee KH, Tam YH, Yeung CK, Chan KW, Sihoe JD, Cheung ST, Mou JW (2009) Laparoscopic excision of choledochal cysts in children: an intermediate-term report. Pediatr Surg Int 25(4):355–360
Le DM, Woo RK, Sylvester K, Krummel TM, Albanese CT (2006) Laparoscopic resection of type 1 choledochal cysts in pediatric patients. Surg Endosc 20(2):249–251
Diao M, Li L, Cheng W (2011) Laparoscopic versus Open Roux-en-Y hepatojejunostomy for children with choledochal cysts: intermediate-term follow-up results. Surg Endosc 25(5):1567–1573
Cherqaoui A, Haddad M, Roman C, Gorincour G, Marti JY, Bonnard A, Guys JM, de Lagausie P (2012) Management of choledochal cyst: evolution with antenatal diagnosis and laparoscopic approach. J Minim Access Surg 8(4):129–133
Diao M, Li L, Cheng W (2012) Timing of surgery for prenatally diagnosed asymptomatic choledochal cysts: a prospective randomized study. J Pediatr Surg 47(3):506–512
Tanaka N, Ueno T, Takama Y, Fukuzawa M (2010) Diagnosis and management of biliary cystic malformations in neonates. J Pediatr Surg 45(11):2119–2123
Yasufuku M, Hisamatsu C, Nozaki N, Nishijima E (2012) A very low-birth-weight infant with spontaneous perforation of a choledochal cyst and adjacent pseudocyst formation. J Pediatr Surg 47(7):E17–E19
Hamada Y, Tanano A, Sato M, Kato Y, Hioki K (1998) Rapid enlargement of a choledochal cyst: antenatal diagnosis and delayed primary excision. Pediatr Surg Int 13(5–6):419–421
Diao M, Li L, Cheng W (2011) Congenital biliary dilatation may consist of 2 disease entities. J Pediatr Surg 46(8):1503–1509
Lacher M, Kuebler JF, Dingemann J, Ure BM (2014) Minimal invasive surgery in the newborn: current status and evidence. Semin Pediatr Surg 23(5):249–256
Li S, Wang W, Yu Z, Xu W (2014) Laparoscopically assisted extrahepatic bile duct excision with ductoplasty and a widened hepaticojejunostomy for complicated hepatobiliary dilatation. Pediatr Surg Int 30(6):593–598
Urushihara N, Fukumoto K, Nouso H, Yamoto M, Miyake H, Kaneshiro M, Koyama M, Nakajima H (2015) Hepatic ductoplasty and hepaticojejunostomy to treat narrow common hepatic duct during laparoscopic surgery for choledochal cyst. Pediatr Surg Int 31(10):983–986
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Kin Wai Edwin Chan, Kim Hung Lee, Siu Yan Bess Tsui, Jennifer Wai Cheung Mou, Yuk Him Peter Tam have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Chan, K.W.E., Lee, K.H., Tsui, S.Y.B. et al. Laparoscopic management of antenatally detected choledochal cyst: a 10-year review. Surg Endosc 30, 5494–5499 (2016). https://doi.org/10.1007/s00464-016-4912-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-016-4912-z