Top

Pediatric Surgery International

Published in:

01-08-2011 | Original Article

Is it necessary to ligate distal common bile duct stumps after excising choledochal cysts?

Authors: Mei Diao, Long Li, Wei Cheng

Published in: Pediatric Surgery International | Issue 8/2011

Abstract

Purpose

After excision of choledochal cysts (CDC), the distal common bile duct (CBD) stumps are conventionally ligated. Yet, the distal common bile duct stump mobilization and ligation carries certain risk of pancreatic duct injury. The current study investigates the feasibility of selectively leaving distal stump unligated in CDC children with stenotic distal CBD.

Methods

Between 2001 and 2010, 270 CDC children successfully underwent laparoscopic cyst excision and Roux-en-Y hepatojejunostomy and were recruited into this study. The distal stump management was based on its radiological morphology. The patients were divided into two groups: (1) non-ligation group (n = 207), where the distal stump was stenotic and was left unligated; (2) ligation group (n = 63), where the distal stump was not stenotic and was ligated. The pancreatic juice leakage rates were compared.

Results

The median follow-up periods in the non-ligation and ligation group were 36 and 33 months, respectively. There was no pancreatic juice leakage in either group.

Conclusion

Not ligating distal stump is a feasible approach for managing CDC with stenotic distal CBD. It simplifies the operative procedure and may minimize pancreatic duct injury.

Miyano T, Li L, Yamada K (2009) Choledochal cyst. In: Gupta D, Sharma S, Azizkhan R (eds) Pediatric Surgery—diagnosis and management. Jayee Brother Medical Publishers (P) LTD, New Delhi, pp 1013–1025

Lee H, Hirose S, Bratton B, Farmer D (2004) Initial experience with complex laparoscopic biliary surgery in children: biliary atresia and choledochal cyst. J Pediatr Surg 39:804–807, discussion 804–807PubMedCrossRef

Le DM, Woo RK, Sylvester K, Krummel TM, Albanese CT (2006) Laparoscopic resection of type 1 choledochal cysts in pediatric patients. Surg Endosc 20:249–251PubMedCrossRef

Ure BM, Nustede R, Becker H (2005) Laparoscopic resection of congenital choledochal cyst, hepaticojejunostomy, and externally made Roux-en-Y anastomosis. J Pediatr Surg 40:728–730PubMedCrossRef

Nguyen Thanh L, Hien PD, Dung le A, Son TN (2010) Laparoscopic repair for choledochal cyst: lessons learned from 190 cases. J Pediatr Surg 45:540–544PubMedCrossRef

Palanivelu C, Rangarajan M, Parthasarathi R, Amar V, Senthilnathan P (2008) Laparoscopic management of choledochal cysts: technique and outcomes—a retrospective study of 35 patients from a tertiary center. J Am Coll Surg 207:839–846PubMedCrossRef

Chowbey PK, Katrak MP, Sharma A, Khullar R, Soni V, Baijal M, Vashistha A, Dhir A, Dewan A (2002) Complete laparoscopic management of choledochal cyst: report of two cases. J Laparoendosc Adv Surg Tech 12:217–221CrossRef

Li SL, Zhang DR, Li YC, Li ZD, Niu AG (2000) Prevention and treatment for pancreatic duct injury during the excision of choledochal cyst. Chin J Pediatr Surg 21:211–213

He XB, Feng D (2008) Surgical treatment for 48 adults with choledochal cysts. J Hepatopancreatobiliary Surg 20:357–358

10.

Li ZF (2004) Post-operative complications in children with choledochal cysts. J Anhui Health Coll 3:34–35

11.

Li L, Feng W, Jing-Bo F, Qi-Zhi Y, Gang L, Liu-Ming H, Yu L, Jun J, Ping W (2004) Laparoscopic-assisted total cyst excision of choledochal cyst and Roux-en-Y hepatoenterostomy. J Pediatr Surg 39:1663–1666PubMedCrossRef

12.

Diao M, Li L, Cheng W (2010) Laparoscopic versus Open Roux-en-Y hepatojejunostomy for children with choledochal cysts: intermediate-term follow-up results. Surg Endosc [Epub ahead of print]

13.

Diao M, Li L, Zhang JS, Cheng W (2010) Laparoscopic-assisted clearance of protein plugs in the common channel in children with choledochal cysts. J Pediatr Surg 45:2099–2102PubMedCrossRef

14.

Diao M, Li L, Zhang JZ, Cheng W (2010) A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective: preliminary results of a prospective randomized study. J Pediatr Surg 45:845–847PubMedCrossRef

15.

Li L, Yamataka A, Wang YX, Wang DY, Wang K, Li ZX, Shimizu T, Yamashiro Y, Zhang JZ, Lane GJ, Miyano T (2003) Anomalous pancreatic duct anatomy, ectopic distal location of the papilla of Vater and congenital biliary dilatation: a new developmental triad? Pediatr Surg Int 19:180–185PubMed

Title: Is it necessary to ligate distal common bile duct stumps after excising choledochal cysts?
Authors: Mei Diao
Long Li
Wei Cheng
Publication date: 01-08-2011
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 8/2011
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-011-2877-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is it necessary to ligate distal common bile duct stumps after excising choledochal cysts?

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2011

The prognostic factors and the outcome of primary isolated fetal ascites

Predictors of prolonged drainage of chylothorax after cardiac surgery: single centre study

Management of testicular rupture after blunt trauma in children

Pediatric living donor liver transplantation for biliary atresia with hepatopulmonary syndrome: the gift of a second wind

Multicystic dysplastic kidney and cystic accessory uterine cavity: a new prenatally diagnosed association

Intestinal mitochondrial apoptotic signaling is activated during oxidative stress