Laparoscopic Surgery in the treatment of children with Choledochal Cyst

Abstract

Objective: To evaluate the clinical effectiveness of laparoscopic surgery in the treatment of children with choledochal cyst.
 Methods: Seventy-six children with congenital choledochal cyst who were admitted to our hospital between February 2016 and April 2017 were selected as research subjects. They were evenly divided into an observation group and a control group using random number table, 38 each group. Patients in the observation group underwent laparoscopic surgery, while patients in the control group underwent the traditional laparotomy. Surgery related indicators and prognosis were compared between the two groups.
 Results: The incision size and intraoperative bleeding volume of the observation group were significantly smaller than those of the control group (P<0.05). The time of passage of flatus and time to take food of the observation group were easier than those of the control group, and the duration of hospitalization and parenteral nutrition of the former was significantly shorter than those of the latter, and the difference had statistical significance (P<0.05). The incidence of postoperative complications in the observation group was 2.6%, significantly lower than that in the control group (10.5%) (P<0.05). There was no recurrence in the observation group during the follow-up period, but there were 5 cases of recurrence (13.1%) in the control group; the difference was statistically significant (P<0.05).
 Conclusion: Compared with the traditional laparotomy, laparoscopic surgery conforms more to the concept of modern medical minimally invasive treatment and has a significant clinical effect in the treatment of congenital choledochal cyst in children. It can effectively promote the disappearance of clinical symptoms and signs, reduce the incidence of postoperative complications and disease recurrence, and improve the surgical efficacy, suggesting high clinical significance and application values.
 doi: https://doi.org/10.12669/pjms.35.3.85
 How to cite this:Qu X, Cui L, Xu J. Laparoscopic Surgery in the treatment of children with Choledochal Cyst. Pak J Med Sci. 2019;35(3):---------. doi: https://doi.org/10.12669/pjms.35.3.85
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

“…The average postoperative follow-up was 29 months, range from 22 to 36 months, and all patients evolved asymptomatically (Table 1). [13].…”

“…But there are also inconveniences, the child has an abdominal cavity small, poor tolerance of the pneumoperitoneum, in addition to the need for an anastomosis bilio-digestive accurate, are aspects that are challenging, and the surgeon requires a long time to acquire the skills and confidence enough, in complex techniques like this, versus with robot-assisted surgery, the learning curve is shorter. However, the laparoscopic approach it has not been widely used, because especially the laparoscopic hepaticojejunostomy are quite technically demanding [13]. Although this approach is safe and effective in the hands of experts [14], and also in hospitals with a high volume of cases.…”

“…It is very important to consider that, laparoscopic choledochal cystectomy and Roux-en-Y hepaticojejunostomy requires excellent skills of operators, and the operation experience needs to be accumulated through clinical practices[13]. Diao., et al found that the surgical time shortened when the number of cases that the operator treated exceeded 35 cases[33], this translates as the learning curve for treatment of the choledochal cyst with laparoscopy conventional.In a Dutch National Study, they included all pediatric patients who underwent a surgical procedure for type I and IV chodedochal cyst between 1989 and 2014, were entered 91 pediatric patients underwent surgery 12 patients (13%) laparoscopic approach, and 79 patients (87%) open, with Roux-en-Y hepaticojejunostomy.Short-term complications of the laparoscopic approach were duodenum perforation and cholangitis, in 2 patients (16.6%), and in five patients (42%), ocurred cholangitis, complications requiring radiological intervention or re-surgery, stricture and incomplete of the choledochal cyst resection.…”

A narrative review of the modern surgical management of pediatric choledochal cysts

“…Since then, myriad articles promoting the feasibility, safety, and outcomes of this approach have followed. (11)(12)(13)(14)(15)(16)(17). Specific findings from these articles will be discussed below; generally, they support previous conclusions that laparoscopy is safe and effective to manage CC, and confers the benefit of decreased intraoperative bleeding and shorter hospital LOS despite an increase in operative time.…”

Laparoscopic excision of type II choledochal cyst arising from the intrapancreatic common bile duct in an adult

“…2 Excision of the lower cyst, which arises from the intrapancreatic common bile duct (CBD), is technically demanding because of its location. Although laparoscopic treatment is being widely performed for CDC, [3][4][5] there have been no reports of laparoscopic excision of a lower type II CDC. We present our experience of laparoscopic excision of a type II CDC arising from the intrapancreatic CBD.…”