Laparoscopic Surgery for Choledochal Cyst in Children: A Case Review of 31 Patients

Abstract

Introduction: The results of the first substantial series of children suffering from choledochal cysts treated using laparoscopic surgery at the Shanghai Children's Medical Center, Shanghai, China are presented. Methods: Data from 31 sequentially treated children (average age 45.2 months, SD 36.5, range 2 to 168 months) with choledochal cyst treated by laparoscopic surgery were collected prospectively. The chief complaints included intermittent abdominal pain, vomiting, jaundice or pancreatitis. Two cases had no clinical symptoms; their diagnoses were based on prenatal ultrasound findings and confirmed postnatally. The laparoscopic technique included excision of the gall bladder and cyst, followed by a Roux-en-Y anastomosis constructed after exteriorization of the small bowel via an infraumbilical trocar incision. After repositioning of the bowel, an end-to-side hepaticojejunostomy was carried out laparoscopically. Results: The procedures were carried out successfully in 27 children and the average operating time was 5.2 hrs (4 - 7.5 hrs). In 4 patients, the operations were converted to open surgery because of a giant cyst (diameter 10 cm; 1 case), serious inflammation and adhesions (2 cases), and hepatic duct malformation (1 case). Complications occurring postoperatively and cured by conservative treatment included hepaticojejunostomosis leakage (1 case), bowel ileus (1 case), pancreatitis (1 case), and pneumonia (1 case). Oral food intake was started within 3 - 5 days and patients were discharged within 7 - 14 days (average 8.6 days). All patients are well with bile-stained stools after an average follow-up of 16.3 months (range 2 - 43 months). The average cost was RMB 19 167 ($ 2522, range RMB 12 600 - 34 538). Conclusions: Laparoscopic resection of congenital choledochal cyst and choledochojejunostomy in children is feasible and safe. The long-term results are good. There was a considerable learning curve during the development of the technique as experienced by the team.

Key words

choledochal cyst - laparoscopic surgery - children

References

• 1 Chowbey P K, Katrak M P, Sharma A, Khullar R, Soni V, Baijal M. et al . Complete laparoscopic management of choledochal cyst: report of two cases.  J Laparoendosc Adv Surg Tech A. 2002;  12 217-221
• 2 De Vries J S, De Vries S, Aronson D C, Bosman D K, Rauws E A, Bosma A. et al . Choledochal cysts: age of presentation, symptoms, and late complications related to Todani's classification.  J Pediatr Surg. 2002;  37 1568-1573
• 3 Duron J J, Hay J M, Msika S, Gaschard D, Domergue J, Gainant A. et al . Prevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery: a retrospective multicenter study. French Association for Surgical Research.  Arch Surg. 2000;  135 208-212
• 4 Farello G A, Cerofolini A, Rebonato M, Bergamaschi G, Ferrari C, Chiappetta A. et al . Congenital choledochal cyst: video-guided laparoscopic treatment.  Surg Laparosc Endosc. 1995;  5 354-358
• 5 Fujisaki S, Akiyama T, Miyake H, Amano S, Tomita R, Fukuzawa M. et al . A case of carcinoma associated with the remained intrapancreatic biliary tract 17 years after the primary excision of a choledochal cyst.  Hepatogastroenterology. 1999;  27 1655-1659
• 6 Koike M, Yasui K, Shimizu Y, Kodera Y, Hirai T, Morimoto T. et al . Carcinoma of the hepatic hilus developing 21 years after biliary diversion for choledochal cyst: a case report.  Hepatogastroenterology. 2002;  49 1216-1220
• 7 Li L, Feng W, Fu J B, Yu Q Z, Liu G, Huang L M. et al . Laparoscopic-assisted total cyst excision of choledochal cyst and Roux-en-Y hepatoenterostomy.  J Pediatr Surg. 2004;  39 1663-1666
• 8 Niewenhuizen M, Reijnen M M, Kuijpers J H, van Goor H. Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective review.  Br J Surg. 1998;  85 1242-1245
• 9 Shimura H, Tanaka M, Shimizu S, Mizumoto K. Laparoscopic treatment of congenital choledochal cyst.  Surg Endosc. 1998;  12 1268-1271
• 10 Srimurthy K R, Ramesh S. Laparoscopic management of pediatric choledochal cysts in developing countries: review of ten cases.  Pediatr Surg Int. 2006;  22 144-149
• 11 Tanaka M, Shimizu S, Mizumoto K, Chijiiwa K, Yamaguchi K, Ogawa Y. Laparoscopically assisted resection of choledochal cyst and Roux-en-Y reconstruction.  Surg Endosc. 2001;  15 545-551
• 12 Todani T, Watanabe Y, Narusue M, Tabuchi K, Okaiima K. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cysts.  Am J Surg. 1977;  134 263-269
• 13 Ure B M, Bax N M, van der Zee D C. Laparoscopy in infants and children: a prospective study on the feasibility and it's impact on routine surgery.  J Pediatr Surg. 2000;  35 1170-1173
• 14 Ure B M, Nustede R, Becker H. Laparoscopic resection of congenital choledochal cyst, hepaticojejunostomy, and externally made Roux-en Y anastomosis.  J Pediatr Surg. 2005;  40 728-730
• 15 Watanabe Y, Sato M, Tokui K, Koga S, Yukumi S, Kawachi K. Laparoscope-assisted minimally invasive treatment for choledochal cyst.  J Laparoendosc Adv Surg Tech A. 1999;  9 415-418
• 16 Wilkens B M, Spitz L. Incidence of postoperative adhesion obstruction following neonatal laparotomy.  Br J Surg. 1986;  73 762-764