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Single-incision laparoscopic hepaticojejunostomy for children with perforated choledochal cysts

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Abstract

Background

Conventionally, perforated choledochal cyst (CDC) is a contraindication of laparoscopic treatment. The current study is to evaluate efficacy of single-incision laparoscopic hepaticojejunostomy (SILH) in children with perforated CDCs.

Methods

One hundred and thirty-three children with perforated CDCs who underwent SILHs in our hospital between August 2011 and August 2017 were reviewed.

Results

Fifteen (11.3%) patients were converted to open procedures due to severe adhesions and oozing. The mean age at SILH was 2.09 years (range 2 days–12.37 years). The average operative time was 3.23 h (range 2–5 h). The mean postoperative hospital stay was 6.25 days (range 4–16 days). The mean time to full diet resumption was 2.18 days (range 2–6 days). The mean duration of drainage was 3.71 days (range 3–10 days). The median follow-up period was 24 months. Postoperative liver function tests and serum amylase levels returned to normal within 1 year. Three (2.5%) patients required blood transfusions because of extensive oozing from intramural micro-vessels of CDCs. Two (1.7%) patients encountered duodenal injuries because of severe adhesions. The duodenum was repaired with double-layer 5–0 PDS running sutures. One (0.8%) patient with giant CDC had abdominal fluids because of extensive dissection of intrapancreatic segment of CDC. He recovered after 10 days of drainage. None of patients had bile leak, anastomotic stenosis, cholangitis, intrahepatic reflux, pancreatic leak, pancreatic calculi formation, pancreatitis, Roux-loop obstruction, or adhesive intestinal obstruction.

Conclusions

Single-incision laparoscopic hepaticojejunostomy is safe and effective for selected patients with perforated CDCs in experienced hands.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People’s Republic of China

    Mei Diao, Long Li & Wei Cheng

  2. Department of Paediatrics and Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia

    Wei Cheng

  3. Department of Surgery, Beijing United Family Hospital, Beijing, China

    Wei Cheng

Authors
  1. Mei Diao
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  2. Long Li
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  3. Wei Cheng
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Corresponding authors

Correspondence to Long Li or Wei Cheng.

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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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Diao, M., Li, L. & Cheng, W. Single-incision laparoscopic hepaticojejunostomy for children with perforated choledochal cysts. Surg Endosc 32, 3402–3409 (2018). https://doi.org/10.1007/s00464-018-6047-x

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  • DOI: https://doi.org/10.1007/s00464-018-6047-x

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