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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2019

Open Access 01-06-2019 | Laparoscopy | Dynamic Manuscript

Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct

Authors: Xiaopan Chang, Xi Zhang, Meng Xiong, Li Yang, Shuai Li, Guoqing Cao, Ying Zhou, Dehua Yang, Shao-tao Tang

Published in: Surgical Endoscopy | Issue 6/2019

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Abstract

Background

Complete cyst excision with Roux-en-Y hepaticojejunostomy is the standard procedure for choledochal cysts (CCs). In recent years, neonates have been increasingly diagnosed with CCs prenatally. Earlier treatment has been recommended to avoid complications. For type IVa malformation without extensive intrahepatic bile duct dilatation, laparoscopic hepaticojejunostomy is technically challenging, and anastomotic stricture is a concern. Therefore, we propose laparoscopic synthetical techniques—laparoscopic excision of cyst and ductoplasty plus widened portoenterostomy to avoid stricture in CCs with a narrow hilar duct.

Methods

An anastomosis was created around the transected end of the common bile duct in 12 minipigs (Group A), and another 12 minipigs (Group B) received conventional cholangiojejunostomy. Anastomotic diameter measurements and cholangiography were conducted at different times. Histological findings of inflammation and scarring were compared. The expression levels of TGF-β1 and type I collagen were detected by real-time quantitative PCR. Between January 2012 and January 2016, laparoscopic excision of cyst and ductoplasty plus widened portoenterostomy were performed on 29 children with confirmed CCs with a narrow portal bile duct who were followed up for 12–48 months.

Results

Group A survived well without obstruction. Slight inflammation and fibrotic tissue were confined to the bile duct periphery. In Group B, five pigs developed stricture. Severe inflammation and diffuse fibrosis affected the whole layer of the anastomosis. Fibrotic biomarkers were significantly higher postoperatively in Group B. Clinically, 29 patients exhibited satisfactory outcomes. No anastomotic stricture has been observed to date.

Conclusions

Laparoscopic synthetical techniques may be a superior option to prevent anastomotic stricture in treating CCs with a narrow portal bile duct.
Appendix
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Metadata
Title
Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct
Authors
Xiaopan Chang
Xi Zhang
Meng Xiong
Li Yang
Shuai Li
Guoqing Cao
Ying Zhou
Dehua Yang
Shao-tao Tang
Publication date
01-06-2019
Publisher
Springer US
Keyword
Laparoscopy
Published in
Surgical Endoscopy / Issue 6/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-06635-4

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