Laparoscopic management of choledochal cysts in infants and children: A review of current practice

Abstract

Aim: Choledochal cyst is characterized by congenital dilatation of the biliary system. Patients with choledochal cyst tend to be symptomatic in their childhood. The aim of this study was to review the current practice in laparoscopic management of choledochal cyst in infants and children. Patients and Methods: A PubMed database search was performed for all the studies on children who underwent laparoscopic excision of choledochal cyst. Additional literature was cited second hand from the first-tier literatures. Results: Studies on i) laparoscopic excision of choledochal cyst and hepaticojejunostomy in children; ii) laparoscopic management of choledochal cyst in antenatally detected choledochal cyst; iii) single incision laparoscopic surgery (SILS) in children with choledochal cyst; iv) robotic assisted laparoscopic surgery in children with choledochal cyst and v) hepaticoduodenostomy in children with choledochal cyst were reviewed. Conclusions: Laparoscopic excision of choledochal cyst and hepaticojejunostomy remains safe and feasible in children and infants. In centers experienced in MIS, SILS and robotic-assisted laparoscopy in the management of children with choledochal cyst were reported to be an alternative approach. The debate on hepaticoduodenostomy versus hepaticojejunostomy in biliary reconstruction will continue until a longterm outcome is available in the future.

Comparison of efficacy and safety of laparoscopic excision and open operation in children with choledochal cysts: A systematic review and update meta-analysis

“…Short-term complications mean which occur during postoperative hospitalization, including bile leakage, gastrointestinal dysfunction, anastomotic leakage, and wound infection, et al [ 26 ]. Meanwhile, long-term complications refer to those happen during the follow-up period, including adhesive ileus, bile duct obstruction, anastomotic stenosis, pancreatitis, and cholangitis, et al As previous studies showed [ 8 , 32 ], laparoscopy with its umbilicus-to-hepatic hilum direction of vision provides a better view of the deep anatomic structures, such as hepatic hilum, portal vein, and hepatic arteries. The magnified view from this direction enables meticulous dissection, excision, and ligature; therefore, prevents injuries of the biliary and pancreatic ducts, promotes hemostasis and minimizes blood loss [ 9 ], which may reduce complications.…”

A giant choledochal cyst: A case reported from Tanzania

“…It aims to fully excise the cyst and restore biliary enteric drainage into the duodenum or via Roux-en-Y hepaticojejunostomy [ 19 ]. Laparoscopic approach is currently the gold standard of minimally invasive surgery (MIS) technique in managing CC in children [ 20 ]. It was first reported in 1995 by Farello [ 21 ], and has been used since for type I and type IVa choledochal cyst excision.…”

“…It was first reported in 1995 by Farello [ 21 ], and has been used since for type I and type IVa choledochal cyst excision. The comparison studies show leak rates, morbidity and mortality in laparoscopic approach are comparable with the open technique [ 22 ], with a metaanalysis by Shen et al in 2015 reporting an added advantage of less blood loss, better cosmesis and a shorter hospital stay [ 23 ], although it is technically demanding [ 20 ]. This approach was not used in our case due to less expertise in laparoscopic surgery and the rare nature of the disease.…”

“…This approach was not used in our case due to less expertise in laparoscopic surgery and the rare nature of the disease. Other MIS techniques including robotic surgery and single incision laparoscopic surgery have been reported recently, with no clear clinical benefit of both as compared to conventional laparoscopic technique [ 20 ].…”

Tratamiento laparoscópico de un quiste de colédoco gigante en un paciente pediátrico

“…Solo algunos reportes de tratamientos por mínima invasión mencionan el tamaño de los quistes, que en promedio es < 5 cm 10,11 . No obstante, el tamaño del quiste no debe ser impedimento para realizar un abordaje laparoscópico 12 .…”