Download PDF
Eur J Pediatr Surg 2022; 32(06): 521-528
DOI: 10.1055/s-0042-1749435
Original Article

The Role of Laparoscopic Treatment of Choledochal Malformation in Europe: A Single-Center Experience and Review of the Literature

Nagoud Schukfeh
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Reem Abo-Namous
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Omid Madadi-Sanjani
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Marie Uecker
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Claus Petersen
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Benno M. Ure
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Joachim F. Kuebler
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background Numerous studies from Asian countries, including large collectives, have reported excellent results after laparoscopic resection of choledochal malformation (CM). However, the role of laparoscopic CM resection is still controversial outside Asia. We aimed to analyze the outcome of laparoscopic CM resection in our institution and to compare our outcome with the data reported in the literature.

Methods All patients who underwent laparoscopic CM resection in our pediatric surgical department from 2002 to 2019 were retrospectively analyzed for surgical details and postoperative complications, which were graded according to the Clavien–Dindo classification. A systematic literature search identified all reports on over 10 cases of laparoscopic pediatric CM resection and surgical details, follow-up, and complication rates were extracted.

Results Fifty-seven patients (72% female) with a mean age of 3.6 + 4.1 years underwent laparoscopic CM resection in our department. Conversion rate was 30%. Total complication rate was 28%. The rate of major complications (Clavien–Dindo grade III or more) was 16% and included stricture of the biliodigestive or enteric anastomosis (n = 4), adhesive ileus (n = 3), portal vein thrombosis (n = 1), and recurrent cholangitis with consecutive liver transplantation (n = 1). With increasing experience, complication rates decreased. The majority of publications on laparoscopic CM resections originated from Asia (n = 36) and reported on low complication rates. In contrast, publications originating from non-Asian countries (n = 5) reported on higher complications following laparoscopic CM resection.

Conclusion Our data indicate that laparoscopic CM resection can be safely performed. The learning curve in combination with the low incidence calls for a centralization of patients who undergo laparoscopic CM resection. There seems to be a discrepancy on complications rates reported from Asian and non-Asian countries following laparoscopic CM resection.

Keywords

choledochal cyst - pediatric - hepatobiliary - minimal invasive surgery - neonatal surgery


Publication History

Received: 17 November 2021

Accepted: 17 March 2022

Article published online:
28 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 van den Eijnden MHA, de Kleine RHJ, de Blaauw I. et al; Nederlandse Studiegroep voor Choledochus Cysten/malformaties (NeSCHoC). Choledochal malformation in children: lessons learned from a Dutch National Study. World J Surg 2017; 41 (10) 2631-2637
    CrossrefPubMedGoogle Scholar
  • 2 Hukkinen M, Björnland K, Gatzinsky V. et al. Management strategies and treatment results of pediatric choledochal malformations in the Nordic countries. HPB (Oxford) 2020; 22 (01) 161-168
    CrossrefPubMedGoogle Scholar
  • 3 Wen Z, Liang H, Liang J, Liang Q, Xia H. Evaluation of the learning curve of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: CUSUM analysis of a single surgeon's experience. Surg Endosc 2017; 31 (02) 778-787
    CrossrefPubMedGoogle Scholar
  • 4 Diao M, Li L, Cheng W. Single-incision laparoscopic hepaticojejunostomy for children with perforated choledochal cysts. Surg Endosc 2018; 32 (07) 3402-3409
    CrossrefPubMedGoogle Scholar
  • 5 Liem NT, Pham HD, Dung A, Son TN, Vu HM. Early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 patients. J Laparoendosc Adv Surg Tech A 2012; 22 (06) 599-603
    CrossrefPubMedGoogle Scholar
  • 6 Dalton BGA, Gonzalez KW, Dehmer JJ, Andrews WS, Hendrickson RJ. Transition of techniques to treat choledochal cysts in children. J Laparoendosc Adv Surg Tech A 2016; 26 (01) 62-65
    CrossrefPubMedGoogle Scholar
  • 7 Stringer MD. Laparoscopic management of choledochal cysts: is a keyhole view missing the big picture?. Pediatr Surg Int 2017; 33 (06) 651-655
    CrossrefPubMedGoogle Scholar
  • 8 Ure BM, Schier F, Schmidt AI, Nustede R, Petersen C, Jesch NK. Laparoscopic resection of congenital choledochal cyst, choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis. Surg Endosc 2005; 19 (08) 1055-1057
    CrossrefPubMedGoogle Scholar
  • 9 Ure BM, Nustede R, Becker H. Laparoscopic resection of congenital choledochal cyst, hepaticojejunostomy, and externally made Roux-en-Y anastomosis. J Pediatr Surg 2005; 40 (04) 728-730
    CrossrefPubMedGoogle Scholar
  • 10 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250 (02) 187-196
    CrossrefPubMedGoogle Scholar
  • 11 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6 (07) e1000100
    CrossrefPubMedGoogle Scholar
  • 12 Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 1977; 134 (02) 263-269
    CrossrefPubMedGoogle Scholar
  • 13 Yeung F, Fung ACH, Chung PHY, Wong KKY. Short-term and long-term outcomes after Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy following laparoscopic excision of choledochal cyst in children. Surg Endosc 2020; 34 (05) 2172-2177
    CrossrefPubMedGoogle Scholar
  • 14 Uecker M, Kuebler JF, Ure BM, Schukfeh N. Minimally invasive pediatric surgery: the learning curve. Eur J Pediatr Surg 2020; 30 (02) 172-180
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Lee H, Kwon W, Han Y, Kim JR, Kim SW, Jang JY. Comparison of surgical outcomes of intracorporeal hepaticojejunostomy in the excision of choledochal cysts using laparoscopic versus robot techniques. Ann Surg Treat Res 2018; 94 (04) 190-195
    CrossrefPubMedGoogle Scholar
  • 16 Gander JW, Cowles RA, Gross ER. et al. Laparoscopic excision of choledochal cysts with total intracorporeal reconstruction. J Laparoendosc Adv Surg Tech A 2010; 20 (10) 877-881
    CrossrefPubMedGoogle Scholar
  • 17 Margonis GA, Spolverato G, Kim Y. et al. Minimally invasive resection of choledochal cyst: a feasible and safe surgical option. J Gastrointest Surg 2015; 19 (05) 858-865
    CrossrefPubMedGoogle Scholar
  • 18 Alizai NK, Dawrant MJ, Najmaldin AS. Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children. Pediatr Surg Int 2014; 30 (03) 291-294
    CrossrefPubMedGoogle Scholar
  • 19 Diao M, Li L, Cheng W. Laparoscopic versus Open Roux-en-Y hepatojejunostomy for children with choledochal cysts: intermediate-term follow-up results. Surg Endosc 2011; 25 (05) 1567-1573
    CrossrefPubMedGoogle Scholar
  • 20 Diao M, Li L, Li Q, Ye M, Cheng W. Single-incision versus conventional laparoscopic cyst excision and Roux-Y hepaticojejunostomy for children with choledochal cysts: a case-control study. World J Surg 2013; 37 (07) 1707-1713
    CrossrefPubMedGoogle Scholar
  • 21 Diao M, Li L, Cheng W. Laparoscopic management for aberrant hepatic duct in children with choledochal cysts. Surg Endosc 2019; 33 (07) 2376-2380
    CrossrefPubMedGoogle Scholar
  • 22 Hong L, Wu Y, Yan Z, Xu M, Chu J, Chen QM. Laparoscopic surgery for choledochal cyst in children: a case review of 31 patients. Eur J Pediatr Surg 2008; 18 (02) 67-71
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Li S, Wang W, Yu Z, Xu W. Laparoscopically assisted extrahepatic bile duct excision with ductoplasty and a widened hepaticojejunostomy for complicated hepatobiliary dilatation. Pediatr Surg Int 2014; 30 (06) 593-598
    CrossrefPubMedGoogle Scholar
  • 24 Liu F, Xu X, Lan M. et al. Total versus conventional laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy in children with choledochal cysts: a case-control study. BMC Surg 2020; 20 (01) 243
    CrossrefPubMedGoogle Scholar
  • 25 Liuming H, Hongwu Z, Gang L. et al. The effect of laparoscopic excision vs open excision in children with choledochal cyst: a midterm follow-up study. J Pediatr Surg 2011; 46 (04) 662-665
    CrossrefPubMedGoogle Scholar
  • 26 Qu X, Cui L, Xu J. Laparoscopic surgery in the treatment of children with choledochal cyst. Pak J Med Sci 2019; 35 (03) 807-811
    PubMedGoogle Scholar
  • 27 Song G, Jiang X, Wang J, Li A. Comparative clinical study of laparoscopic and open surgery in children with choledochal cysts. Saudi Med J 2017; 38 (05) 476-481
    CrossrefPubMedGoogle Scholar
  • 28 Tan Y, Shen Y, Li L, Yu J. Protocol for enhanced recovery after surgery with 3D laparoscopic excision for choledochal cysts can benefit the recovery process. Pediatr Surg Int 2020; 36 (05) 643-648
    CrossrefPubMedGoogle Scholar
  • 29 Tang Y, Li F, He G. Comparison of single-incision and conventional laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for children with choledochal cysts. Indian J Surg 2016; 78 (04) 259-264
    CrossrefPubMedGoogle Scholar
  • 30 Tang ST, Yang Y, Wang Y. et al. Laparoscopic choledochal cyst excision, hepaticojejunostomy, and extracorporeal Roux-en-Y anastomosis: a technical skill and intermediate-term report in 62 cases. Surg Endosc 2011; 25 (02) 416-422
    CrossrefPubMedGoogle Scholar
  • 31 Wang B, Feng Q, Mao JX, Liu L, Wong KK. Early experience with laparoscopic excision of choledochal cyst in 41 children. J Pediatr Surg 2012; 47 (12) 2175-2178
    CrossrefPubMedGoogle Scholar
  • 32 Xie X, Li K, Wang J, Wang C, Xiang B. Comparison of pediatric choledochal cyst excisions with open procedures, laparoscopic procedures and robot-assisted procedures: a retrospective study. Surg Endosc 2020; 34 (07) 3223-3231
    CrossrefPubMedGoogle Scholar
  • 33 Xu D, Tang K, He S. A modified technique of single-incision laparoscopic hepaticojejunostomy for children with choledochal cysts. BMC Surg 2019; 19 (01) 36
    CrossrefPubMedGoogle Scholar
  • 34 Yu BH, Lin F. Clinical effects in resection of congenital choledochal cyst of children and jejunum Roux-Y anastomosis by laparoscope. Eur Rev Med Pharmacol Sci 2016; 20 (21) 4530-4534
    PubMedGoogle Scholar
  • 35 Zhang B, Wu D, Fang Y. et al. Early complications after laparoscopic resection of choledochal cyst. Pediatr Surg Int 2019; 35 (08) 845-852
    CrossrefPubMedGoogle Scholar
  • 36 Zheng J, Li Z, Ye Y, Wang B. Short-term complications after laparoscopic choledochal cyst radical surgery: prevention and treatment. Front Surg 2020; 7: 583210
    CrossrefPubMedGoogle Scholar
  • 37 Zhuansun D, Jiao C, Meng X, Xiao J, He Y, Feng J. A study of three-dimensional versus two-dimensional laparoscopic surgery in resection of congenital choledochal cyst of children and jejunum Roux-en-Y anastomosis. J Laparoendosc Adv Surg Tech A 2020; 30 (03) 344-349
    CrossrefPubMedGoogle Scholar
  • 38 Chan KW, Lee KH, Tsui SY, Mou JW, Tam YH. Laparoscopic management of antenatally detected choledochal cyst: a 10-year review. Surg Endosc 2016; 30 (12) 5494-5499
    CrossrefPubMedGoogle Scholar
  • 39 Chan KWE, Lee KH, Wong HYV, Tsui SYB, Mou JWC, Tam YHP. Comparison of characteristics and outcomes in antenatally and postnatally detected choledochal cyst in infants and young children in a laparoscopic surgery center. J Laparoendosc Adv Surg Tech A 2020; 30 (11) 1237-1241
    CrossrefPubMedGoogle Scholar
  • 40 Lee KH, Tam YH, Yeung CK. et al. Laparoscopic excision of choledochal cysts in children: an intermediate-term report. Pediatr Surg Int 2009; 25 (04) 355-360
    CrossrefPubMedGoogle Scholar
  • 41 Senthilnathan P, Patel ND, Nair AS, Nalankilli VP, Vijay A, Palanivelu C. Laparoscopic management of choledochal cyst-technical modifications and outcome analysis. World J Surg 2015; 39 (10) 2550-2556
    CrossrefPubMedGoogle Scholar
  • 42 Tanaka Y, Tainaka T, Hinoki A. et al. Risk factors and outcomes of bile leak after laparoscopic surgery for congenital biliary dilatation. Pediatr Surg Int 2021; 37 (02) 235-240
    CrossrefPubMedGoogle Scholar
  • 43 Yamataka A, Lane GJ, Cazares J. Laparoscopic surgery for biliary atresia and choledochal cyst. Semin Pediatr Surg 2012; 21 (03) 201-210
    CrossrefPubMedGoogle Scholar
  • 44 Miyano G, Koyama M, Miyake H. et al. Comparison of laparoscopic hepaticojejunostomy and open hepaticojejunostomy. Can stenosis of the hilar hepatic duct affect postoperative outcome?. Asian J Endosc Surg 2017; 10 (03) 295-300
    CrossrefPubMedGoogle Scholar
  • 45 Lee JH, Kim SH, Kim HY, Choi YH, Jung SE, Park KW. Early experience of laparoscopic choledochal cyst excision in children. J Korean Surg Soc 2013; 85 (05) 225-229
    CrossrefPubMedGoogle Scholar
  • 46 Ryu HS, Lee JY, Kim DY, Kim SC, Namgoong JM. Minimally-invasive neonatal surgery: laparoscopic excision of choledochal cysts in neonates. Ann Surg Treat Res 2019; 97 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 47 Yoon JH, Hwang HK, Lee WJ, Kang CM. Minimally invasive surgery for choledochal cysts: laparoscopic versus robotic approaches. Ann Hepatobiliary Pancreat Surg 2021; 25 (01) 71-77
    CrossrefPubMedGoogle Scholar
  • 48 Ng JL, Salim MT, Low Y. Mid-term outcomes of laparoscopic versus open choledochal cyst excision in a tertiary paediatric hospital. Ann Acad Med Singapore 2014; 43 (04) 220-224
    CrossrefPubMedGoogle Scholar
  • 49 Liem NT, Pham HD, Vu HM. Is the laparoscopic operation as safe as open operation for choledochal cyst in children?. J Laparoendosc Adv Surg Tech A 2011; 21 (04) 367-370
    CrossrefPubMedGoogle Scholar
  • 50 Nguyen Thanh L, Hien PD, Dung A, Son TN. Laparoscopic repair for choledochal cyst: lessons learned from 190 cases. J Pediatr Surg 2010; 45 (03) 540-544
    CrossrefPubMedGoogle Scholar
  • 51 Son TN, Liem NT, Hoan VX. Transumbilical laparoendoscopic single-site surgery with conventional instruments for choledochal cyst in children: early results of 86 cases. J Laparoendosc Adv Surg Tech A 2014; 24 (12) 907-910
    CrossrefPubMedGoogle Scholar
  • 52 Talini C, DE-Carvalho BCN, Antunes LA. et al. Choledochal cyst in the pediatric population: experience of 13 laparoscopic procedures in two years at a single institution. Rev Col Bras Cir 2018; 45 (03) e1854
    CrossrefPubMedGoogle Scholar