Laparoscopic Construction of Hand-sewn Roux-en-Y Limb: A Safe and Effective Means for Total Laparoscopic Radical Pediatric Choledochal Cyst Excision

Abstract

Background Laparoscopic or robot-assisted surgery has become the main pediatric minimal invasive surgery for a choledochal cyst (CDC). However, the Roux-en-Y jejunal limb was created extracorporeally in most reports and intracorporeally in a few reports using an endoscopic stapler. This study aimed to validate the safety and effectiveness of laparoscope-assisted Roux-en-Y jejunal limb created intracorporeally in pediatric minimal invasive surgery for a choledochal cyst (CDC) by hand-sewing. Methods Patients diagnosed with CDC between January 2020 and April 2022 were included in this retrospective analysis. We collected data on clinical characteristics, operative details, time for performing hand-sewn jejunum-jejunum anastomosis, and postoperative outcomes. Results Hand-sewn laparoscope-assisted Roux-en-Y jejunal limb was performed successfully in 21 cases. The median age of the patient was 5.8 years. The median age at surgery was 3.3 ± 3.1 years (26 days–13.6 years). The types of cysts included 12 Ia, 7 Ic, and 2 IVa. The mean operative duration was (216.5 ± 25.2) min, intraoperative bleeding volume was7 ± 2.3 ml, average postoperative time to start oral intake was 2.1 ± 0.4 days, average postoperative drainage tube indwelling time was 2.6 ± 1.1 days, and postoperative hospital stay was 5.3 ± 1.1 days. The follow-up period was 6 to 25 months. Complications (including anastomotic stenosis or fistula, pancreatitis, cholangitis, or death) were not observed in any patients. Conclusions Total laparoscope-assisted construction of hand-sewn Roux-en-Y limb, excision of the cyst, and hepaticojejunostomy are feasible and safe in the treatment for pediatric CDC. It may also has the following advantages: rapid recovery of postoperative gastrointestinal function, short hospitalization, no age limit on the patient and no additional hospitalization costs.