Laparoscopic management for aberrant hepatic duct in children with choledochal cysts

Diao, Mei; Li, Long; Wei, Cheng

doi:10.1007/s00464-019-06807-w

Cited by 13 publications

(8 citation statements)

References 15 publications

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“…This anomaly it is difficult to be detected by preoperative examination and is easy to be missed intraoperatively. In children with cholecochal cysts their recognition and treatment based on subtype of anomaly, with ductoplasty and the hepaticojejunostomy is an efficacious management [44].…”

Section: Resultsmentioning

confidence: 99%

Experience in the Treatment of Choledochal Cyst with Robot-Assisted Surgery in Children: and "The Current State of Minimally Invasive Surgery in this Anomaly”

Arellano¹

2019

Act Scie Paedia

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Report our experience in the treatment of choledochal cyst with robot-assisted surgery in children and perform a current analysis of both approaches of minimally invasive surgery, for this anomaly. Results:We treated 4 patients with choledochal cyst, relation 1:3 female, the averages was in age 3 years, weight 15 kg and height 94.2 cm. Type 1-A cysts were three and one 1-C, the average size of the cysts, 9.6 cm. Clinically, they presented: abdominal mass 3, jaundice episode 3 and fever 2. The following are average values of: total surgical times 360 min and console surgery time 230 min, bleeding 32.5 ml, and postoperative stay 4.7 days. Conversions, complications and mortality 0%. Follow-up average 29 months, and all patients are asymptomatic. Currently, the number of children with choledochal cyst treated with robotic surgery, barely reaches about 3%, in relation to those treated with conventional laparoscopy. The initial experience was published with laparoscopy in Oct-1995 and with robotic surgery in Apr-2006. Conclusions: Our results are encouraging, and show the advantages of robotic surgery, although our experience is limited to a few cases. Robotic surgery for the treatment of choledochal cyst is feasible and safe. The current results with both minimally invasive approaches are very similar, but we consider that it represents an important bias, the great advantage in the application that conventional laparoscopy takes to robotic surgery. To date, very few pediatric surgeons in the world have applied robotic surgery to the choledochal cyst. Material and Methods:Study observational, prospective, and longitudinal, in pediatric patients with choledochal cyst treated with robotic-assisted surgery, from Jul-2016 to Apr-2019. The diagnosis was made with laboratory studies, USG and cholangioresonance.The surgery performing one part by laparoscopy, the extracorporeal Roux-en-Y, and other part with robotic assistance (cholecystectomy, retrocolic Roux-en-Y, and the hepaticojejunostomy). We use 5 trocars, 4 robotics and a laparoscopic. Registered variables: demographic data, cysts according to Todani's classification, size, clinic, total and robotic surgery time, bleeding, conversions, complications, postoperative stay and follow-up. We carry out a detailed non-systematic review of previous publications on this pathology with conventional laparoscopic and robotic surgery. A choledochal cyst is a rare congenital cystic dilatation of the extra or intrahepatic biliary tract or both. It was first described by Vater and Ezler in 1723 [1].Choledochal cysts have an incidence of 1 in 100,000-150,000 live births in the western population, but reported to be as high as 1 in 13,500 live births in the United States and 1 in 15,000 in Australia. The incidence is higher in Asian population with an incidence of 1 in 1000, of which about two-third cases are reported from Japan. Choledochal cysts are diagnosed in childhood about 75%, also have an unexplained female:male preponderance, commonly reported as 4:1 to 3:1 [2].

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Section: Resultsmentioning

confidence: 99%

Experience in the Treatment of Choledochal Cyst with Robot-Assisted Surgery in Children: and "The Current State of Minimally Invasive Surgery in this Anomaly”

Arellano¹

2019

Act Scie Paedia

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“…Recently, laparoscopic and robot-assisted laparoscopic surgeries for CBD have been introduced in several institutions. 9,12,13,24,25 Anatomical variations in the hepatic arteries have been classified by Hiatt. 15 A recent report from China showed no difference in the frequency of anatomical variations of the hepatic arteries based on Hiatt's classification in patients with CBD compared with the normal population 2,3,5 ; however, ARHA, which is excluded from Hiatt's classification and runs ventral to the CHD, has been reported to be more prevalent in patients with CBD (13%-33%) than in the normal population (10%-17%).…”

Section: Discussionmentioning

confidence: 99%

“…For example, Mei et al reported their experience with laparoscopic surgery in 60 patients with CBD with APHD, detailing the anatomy of the aberrant hepatic duct and the usefulness of selecting a technique for each variation. 12 In contrast, Xiaolong et al compared the results of laparoscopic and robot-assisted surgery in patients with CBD with APHD and reported the safety and usefulness of robot-assisted surgery. 13 In our institution, single-hole hepaticojejunostomy for patients with CBD with APHD was performed in seven of eight cases.…”

Section: Discussionmentioning

confidence: 99%

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Variations of the hepatic artery and bile duct in patients with pancreaticobiliary maljunction: Impact on postoperative outcomes

Takada,

Uchida,

Hinoki

et al. 2023

J Hepato Biliary Pancreat

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PurposePreoperative comprehension of the anatomical variations of the hepatic artery and bile duct is essential for safe laparoscopic surgery for pancreaticobiliary maljunction (PBM). This study aimed to investigate the impact of anatomical variations of the hepatic artery and bile duct on surgical technique and postoperative complications.MethodsWe conducted a retrospective review of patients with PBM who underwent laparoscopic surgery at our institution between January 2014 and December 2022 to investigate anatomical variations in the hepatic artery and bile duct, surgical technique, and postoperative complications.ResultsWe included 112 patients with PBM, with a median age of 4 years (interquartile range, 0–55). Overall, 29 of 112 patients had an aberrant right hepatic artery (ARHA) running ventral to the common hepatic duct (CHD), and they underwent hepaticojejunostomy on the ventral side of the ARHA. Additionally, eight of 112 patients had an aberrant posterior hepatic duct (APHD), which was joined to the CHD in all but one case. The presence of APHD was associated with postoperative bile leak occurrence.ConclusionPerforming hepaticojejunostomy ventral to the ARHA is important to prevent complications. Furthermore, APHD may be a risk factor for postoperative bile leak and requires careful bile duct plasty.

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“…When this technique was combined with MRCP, the preoperative biliary tract structure was fully revealed. Such imaging allows surgeons to not only preoperatively produce more comprehensive programs 6,7 but also reduces the necessity of intraoperative cholangiography. This in turn shortens the operation time and prevents cholangiography-related complications such as allergy or the vagal cardiobiliary reflex.…”

mentioning

confidence: 99%

Computed tomography reconstruction of an aberrant hepatic duct in a child with a congenital choledochal cyst

Guo

Yang

2022

ANZ Journal of Surgery

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Laparoscopic management for aberrant hepatic duct in children with choledochal cysts

Cited by 13 publications

References 15 publications

Experience in the Treatment of Choledochal Cyst with Robot-Assisted Surgery in Children: and "The Current State of Minimally Invasive Surgery in this Anomaly”

Experience in the Treatment of Choledochal Cyst with Robot-Assisted Surgery in Children: and "The Current State of Minimally Invasive Surgery in this Anomaly”

Variations of the hepatic artery and bile duct in patients with pancreaticobiliary maljunction: Impact on postoperative outcomes

Computed tomography reconstruction of an aberrant hepatic duct in a child with a congenital choledochal cyst

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