Totally Laparoscopic Management of Choledochal Cyst: Roux-en-Y Jejunojejunostomy and Wide Hepaticojejunostomy with Hilar Ductoplasty

Abstract

Laparoscopic surgery comprising excision of the extrahepatic bile duct, Roux-en-Y limb formation, and wide hepaticojejunostomy with hilar ductoplasty appears to be feasible for children with choledochal cyst. When there is a stricture near the confluence of the hepatic ducts, laparoscopic ductoplasty appears to be feasible for the surgeon with an advanced laparoscopic skill set.

Laparoscopic Repair for Choledochal Cyst in Children: Current Status

“…6 The standard investigations include abdominal ultrasound and magnetic resonant cholangiogram, and they WJOLS Laparoscopic Repair for Choledochal Cyst in Children: Current Status try to clarify the type of bile duct dilatation and to rule out pancreatobiliary malunion. 7 As the antenatal ultrasonography is getting more popular and easily available, more diagnoses are made antenatally. This enables a better communication with parents and an earlier surgery with less disease-related complications and an easier dissection during the surgical procedure as a result of decreased periductal inflammation.…”

“…Nevertheless, in the early part of their learning curve, surgeons can adopt the extracorporeally method before embarking on a totally laparoscopic approach. 7,8,10,14 Regarding the type of suturing at the time of the hepaticoenterostomy, it can be done by running 4,12 or interrupted sutures. 7,[9][10][11] The latest are used when the diameter of the CHD is less than 1 or 1.5 cm while others do so in all cases to avoid late anastomosis strictures.…”

“…Anastomotic leakage is the most frequent early complications and in the majority of cases they are treated conservatively with good outcome. 1,3,4,7,9,[12][13][14]16 The mid-term complications rate is 6.1% with a median follow-up of 29.1 months: Recurrent anastomotic strictures, residual cyst, cholangitis, bilious reflux (only in cases of HD), pancreatitis, small bowel obstruction and ventral hernia. 1,3,4,[11][12][13][14] Intrahepatic stones and biliary carcinoma are potential complications that were not seen in the series reviewed.…”

“…Anastomotic stricture is a main concern an there are some methods to avoid it: Ductoplasty in cases of ductal strictures at the moment of surgery, to leave a small cuff of the cyst to facilitate the anastomosis and to make a wide HJ. 3,7,8,12 Liem et al 16 have compared laparoscopic vs open choledochal cyst repair, in the laparoscopic procedure the operative time was significantly longer; the need of blood transfusion was lower (3.2 vs 11.1%, p = 0.001); the postoperative evolution was more favorable with less complications (3.9 vs 5.5%) and the reintervention rate was also lower (0.3 vs 3.6%). The intraoperative complications were similar in both groups (0.6 vs 0.3%).…”

Laparoscopic Choledochojejunostomy in Various Hepatobiliary and Pancreatic Surgeries: A Single Surgeon's Experience

“…6,7 Among several types of biliary-enteric anastomosis, choledochojejunostomy (CJ) is the most commonly used method. As in open surgery, CJ is one of the most frequently used methods for laparoscopic biliary-enteric anastomosis.…”