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- Title
Transition of Techniques to Treat Choledochal Cysts in Children.
- Authors
Dalton, Brian G.A.; Gonzalez, Katherine W.; Dehmer, Jeffrey J.; Andrews, Walter S.; Hendrickson, Richard J.
- Abstract
<bold>Introduction: </bold>Traditionally open resection with hepaticojejunostomy (HJ) reconstruction has been the surgical treatment for cases of choledochal cyst. Our center has recently transitioned from open to laparoscopic and HJ to hepaticoduodenostomy (HD) as our preferred method of excision and biliary reconstruction. Our initial experience is presented here.<bold>Materials and Methods: </bold>A single-center retrospective chart review was performed from 2005 to 2014. All patients undergoing surgical treatment for choledochal disease were considered.<bold>Results: </bold>During the study period 18 patients had surgical treatment for choledochal cyst disease. The average age of all patients was 4.7 years (range, 2 months-15.5 years). Eleven of these patients had laparoscopic excision and reconstruction. Of these 11 patients, 7 had an HD anastomosis. Comparing the laparoscopic with the open group and the HD with the HJ group, there was no significant difference in operative time, estimated blood loss, time to regular diet, length of stay, or complication rate. Mean follow-up of 3.1 years revealed no documented cases of bile reflux or cholangitis. A recent adaptation in technique may improve ease of HD anastomosis. In this method, two strands of temporary monofilament suture cut to 8-10 cm each are tied extracorporeally. This knot is then placed on the outside of the medial corner. The anastomosis is then completed in a running fashion with the two strands and then secured intracorporeally at the lateral corner.<bold>Conclusions: </bold>Laparoscopic choledochal cyst resection with both HJ and HD reconstruction appears safe and has equivalent outcomes to open procedures in our series.
- Subjects
CYSTS (Pathology); SURGERY; SURGICAL excision; JEJUNOSTOMY; LAPAROSCOPIC surgery; BLOOD loss estimation; LENGTH of stay in hospitals; DUODENUM surgery; JEJUNUM surgery; LIVER surgery; BILE duct abnormalities; COMPARATIVE studies; LAPAROSCOPY; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RESEARCH; EVALUATION research; TREATMENT effectiveness; RETROSPECTIVE studies; SURGICAL anastomosis; CHOLANGITIS
- Publication
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2016, Vol 26, Issue 1, p62
- ISSN
1092-6429
- Publication type
journal article
- DOI
10.1089/lap.2015.0123