Top

Pediatric Surgery International

Published in:

Open Access 01-08-2019 | Magnetic Resonance Cholangio Pancreatography | Original Article

Early complications after laparoscopic resection of choledochal cyst

Authors: Bing Zhang, Dianming Wu, Yifan Fang, Jianxi Bai, Wenhua Huang, Mingkun Liu, Jiancai Chen, Le Li

Published in: Pediatric Surgery International | Issue 8/2019

Abstract

Purpose

To investigate the causes and treatments of early complications involving laparoscopic radical resection of choledochal cyst and summarize the experience.

Methods

Children with choledochal cyst treated by laparoscopy in the Department of Pediatric Surgery, Fujian Provincial Maternity and Children’s Hospital, and Guangzhou Women and Children’s Medical Centre, from March 2016 to May 2018, were retrospectively analysed. Demographics, causes and treatments of early complications, liver function analysis and ultrasonography were collected.

Results

In total, 231 cases were included; 204 were Type I (156 Type Ia and 46 Type Ic) and 27 were Type IV. No mortality was observed, and 224 cases were successfully laparoscopically operated, while 7 cases were converted to open surgery. Fifteen cases of postoperative developed biliary fistula. There were jejunal Roux loop obstruction in 2 cases and multiple intussusception, anastomotic stenosis after hepaticojejunostomy, residual of choledochal cyst and pancreatic fistula in one each. Patients were followed up ranging from 4 months to 48 months (12.6 ± 0.3 months on average). Postoperative ALT, AST, GGT, TBIL and DBIL all returned to normal during this time. Ultrasonography indicated 5 cases of widened Glisson’s sheath and 1 case of intrahepatic hyperdense shadow.

Conclusion

Early complications of laparoscopic radical resection of choledochal cyst can be minimized by properly managing preoperative indications and contraindications, carefully interpreting the magnetic resonance cholangiopancreatography results and accumulating experience by the surgeons.

Makin E, Davenport M (2012) Understanding choledochal malformation. Arch Dis Child 97(1):69–72. https://doi.org/10.1136/adc.2010.195974 CrossRefPubMed

Urushihara N, Fukumoto K, Yamoto M et al (2018) Characteristics, management, and outcomes of congenital biliary dilatation in neonates and early infants: a 20-year, single-institution study. J Hepato-Bil-Pan Sci. https://doi.org/10.1002/jhbp.590 CrossRef

Ronnekleiv-Kelly SM, Soares KC, Ejaz A et al (2016) Management of choledochal cysts. Curr Opin Gastroen 32(3):225. https://doi.org/10.1097/MOG.0000000000000256 CrossRef

Todani T (1997) Congenital choledochal dilatation: classification, clinical features, and long-term results. J Hepato-biliary-pan 4(3):276–282. https://doi.org/10.1007/bf02489025 CrossRef

Hamada Y, Ando H, Kamisawa T et al (2016) Diagnostic criteria for congenital biliary dilatation 2015. J Hepato-bil-pan Sci 23(6):342–346. https://doi.org/10.1002/jhbp.346 CrossRef

Kamisawa T, Ando H, Hamada Y et al (2014) Diagnostic criteria for pancreaticobiliary maljunction 2013. J Hepato-bil-pan Sci 21(3):159–161. https://doi.org/10.1002/jhbp.57 CrossRef

Liu Y, Yao X, Li S et al (2014) Comparison of therapeutic effects of laparoscopic and open operation for congenital choledochal cysts in adults. Gastroent Res Pract 3:670260. https://doi.org/10.1155/2014/670260 CrossRef

Qiao G, Li L, Li S et al (2015) Laparoscopic cyst excision and Roux-Y hepaticojejunostomy for children with choledochal cysts in China: a multicenter study. Surg Endosc 29(1):140–144. https://doi.org/10.1007/s00464-014-3667-7 CrossRefPubMed

Ahmed B, Sharma P, Leaphart CL (2017) Laparoscopic resection of choledochal cyst with Roux-en-Y hepaticojejunostomy: a case report and review of the literature. Surg Endosc 31(8):1–6. https://doi.org/10.1007/s00464-016-5346-3 CrossRef

10.

Shaikh IA, Thomas H, Joga K et al (2010) Post-cholecystectomy cystic duct stump leak: a preventable morbidity. J Digest Dis 10(3):207–212. https://doi.org/10.1111/j.1751-2980.2009.00387.x CrossRef

11.

Diao M, Li L, Cheng W (2016) Laparoscopic redo hepaticojejunostomy for children with choledochal cysts. Surg Endosc 30(12):1–7. https://doi.org/10.1007/s00464-016-4915-9 CrossRef

12.

Agur AMR, Dalley IIAF (2012) Abdomen-Bliliatry ducts. In: Agur AMR (ed) Grant’s atlas of anatomy, 13th edn. Lippincoot Williams & Wilkins, Philadelphia, pp 160–164

13.

Mei D, Long L, Wei C (2016) Recurrence of biliary tract obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cysts. Surg Endosc 30(9):3910–3915. https://doi.org/10.1007/s00464-015-4697-5 CrossRef

14.

Tang ST, Yang Y, Wang Y et al (2011) Laparoscopic choledochal cyst excision, hepaticojejunostomy, and extracorporeal Roux-en-Y anastomosis: a technical skill and intermediate-term report in 62 cases. Surg Endosc 25(2):416–422. https://doi.org/10.1007/s00464-010-1183-y CrossRefPubMed

15.

Diao M, Li L (2013) Role of laparoscopy in treatment of choledochal cysts in children. Pediatr Surg Int 29(4):317–326. https://doi.org/10.1007/s00383-013-3266-z CrossRefPubMed

16.

Liuming H, Hongwu Z, Gang L et al (2011) The effect of laparoscopic excision vs open excision in children with choledochal cyst: a midterm follow-up study. J Pediatr Surg 46(4):662–665. https://doi.org/10.1016/j.jpedsurg.2010.10.012 CrossRefPubMed

17.

Pulvirenti A, Ramera M, Bassi C (2017) Modifications in the International Study Group for Pancreatic Surgery (ISGPS) definition of postoperative pancreatic fistula. Transl Gastroenterol Hepatol 2(12):107. https://doi.org/10.21037/tgh.2017.11.14 CrossRefPubMedPubMedCentral

18.

Cheng D, Liu N, Zhaodong W et al (2016) Value of drain fluid amylase level obtained on the first postoperative day in prediction of pancreatic fistula. Chin J Gen Surg 25(9):1307–1312. https://doi.org/10.1002/hed.10272 CrossRef

19.

Urushihara N, Fukumoto K, Fukuzawa H et al (2012) Long-term outcomes after excision of choledochal cysts in a single institution: operative procedures and late complications. J Pediatr Surg 47(12):2169–2174. https://doi.org/10.1016/j.jpedsurg.2012.09.001 CrossRefPubMed

Title: Early complications after laparoscopic resection of choledochal cyst
Authors: Bing Zhang
Dianming Wu
Yifan Fang
Jianxi Bai
Wenhua Huang
Mingkun Liu
Jiancai Chen
Le Li
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Cholangio Pancreatography
Laparoscopy
Published in: Pediatric Surgery International / Issue 8/2019
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-019-04489-y

At a glance: The STEP trials

Springer Medicine

Early complications after laparoscopic resection of choledochal cyst

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2019

Abnormal serum vitamin A levels and retinoic acid receptor α expression patterns in children with anorectal malformation

Letter to editor re: Baba T, Mukai M, Masuya R, et al. (2019) The long-term health-related quality of life in patients operated for choledochal cyst. Pediatr Surg Int 35:539–546

An investigation of social determinants of health and outcomes in pediatric nonaccidental trauma

Acid and bolus exposure in pediatric reflux disease according to the presence and severity of esophageal mucosal lesions

Letter to the Editor concerning: “Inguinal hernia in neonates and ex-preterm: complications, timing and need for routine contralateral exploration”

Letter to the Editor concerning: “the non-visualized appendix and secondary signs on ultrasound for pediatric appendicitis in the community hospital setting”