Laparoscopic management of pediatric choledochal cysts in developing countries: review of ten cases

Abstract

We report laparoscopic management of choledochal cysts (CDC) in 10 children. We dissect the CDC using conventional mono- and bi-polar diathermy up to the lower end, ligate or clip it at the lowest possible level and divide it. The proximal end is divided after leaving a sufficient cuff for anastomosis. In the first three cases, we formally opened to complete the biliary-enteric anastomosis. However, in the subsequent seven cases, we made a small midline incision to develop a Roux-en Y loop, and the anastomosis was then completed by intra-corporeal suturing after re-creating the pneumo-peritoneum. Apart from biliary leak in one case, we did not encounter any major complications. The mean operative time was 4.2 h. We have discussed the technical points in the study. We conclude that CDC is eminently suitable for laparoscopic correction; it requires advanced skills and expertise for precise dissection and meticulous suturing in restricted spaces. If the case selection is good and if the team is experienced, CDC can be effectively managed using laparoscopy even without a sophisticated equipment. The wound- and scar-related morbidity is minimized.

Management of Type I Choledochal Cyst in Adult: Totally Laparoscopic Resection and Roux-en-Y Hepaticoenterostomy

“…Anastomotic leak rates range from 0% to 20%, as reported in a study. 22 A series of 100 patients by Ohi et al 23 documented only one complication in the immediate postoperative setting-bile leakage at the hepaticoenterostomy, which closed without a reoperation. In our study, we had a self-limited hepaticojejunal anastomotic leak rate of 12.1%.…”

Laparoscopic-assisted clearance of protein plugs in the common channel in children with choledochal cysts

“…However, these instruments may not be readily available in some regions of developing countries and hence are not used even in open surgery for CDC [13]. In our series, irrigation via catheter inserted in the common channel has been proven to be a simple, safe, and reliable way to remove the protein plugs.…”

Laparoscopic treatment of congenital choledochal cyst and hepaticojejunostomy with extracorporeal Roux-en-Y anastomosis: technical aspects and early experience with three cases

“…In the laparoscopic literature, the rate of bile leak has ranged from 0 to o n l y 20%. 5,11,12 Ure and colleagues reported a case of early small bowel obstruction at the eighth postoperative day, which required a minilaparotomy. 13 Main late complications include cholangitis, anastomotic stricture, intrahepatic calculi, and bowel obstruction.…”