Resection of Congenital Choledochal Cyst,Hepaticojejunostomy,and Extra-Abdominal Roux-en-Y Anastomosis:Middle-term Results of 50 Cases / 中国微创外科杂志

ABSTRACT

Objective To assess the middle-term results of laparoscopy in resection of congenital choledochal cyst,hepaticojejunostomy,and extra-abdominal Roux-en-Y anastomosis. Methods We retrospectively studied 50 patients who had undergone laparoscopic choledochal cyst excision in our institute from 2005 to 2008.For large cysts,we dissected and separated the cyst at the middle portion,and then opened the inferior wall of the cyst to dissect the posterior wall of the cyst from the portal vein.For small cysts,we divided the cysts circumferentially and then completely excised the dilated bile duct.When the cyst was intensely inflamed,excision of the cysts was performed as Lilly's technique.Roux-en-Y jejunojejunostomy was performed extracorporeally through an umbilical incision(1.5 cm),afterwards,end-to-side anastomosis was carried out intracorporeally.The conversion to open surgery,and morbidity and mortality rates of the patients was analyzed.Results The cysts were completely excised in 16 cases,and Lilly's technique was performed on 34 cases.One patient was converted to open surgery due to hemorrhage resulted from recurrent inflammatory-caused tight adhesion between the cyst and surrounding tissues.The mean operation time was 226 minutes(range 190 to 450 minutes).Eight patients received blood transfusion during the operation.The children were discharged from hospital in 6 to 16 days after the surgery(mean,8 days).A mean of 26 months follow-up was achieved in 49 patients(ranged 3 to 39 months).Four patients developed complications one of them showed bile leakage and then were cured by intra-abdominal drainage;one patient developed acute pancreatitis and one suffered from adhesive small bowel obstruction,both recovered after conservative treatment;intestinal necrosis was detected in one patient,who received another operation for resection of the necrotic bowel and anastomosis of the bile duct and intestine.In the other 45 patients,no abdominal pain,fever,jaundice,etc.were detected.No patient showed bile duct stenosis or reflux gastritis,no one died because of the surgery.Conclusions Laparoscopic approach is effective for congenital choledochal cyst,hepaticojejunostomy,and extra-abdominal Roux-en-Y anastomosis.Dissection of the posterior cyst wall to avoid injury to the portal vein is the key to the procedures,while extra-abdominal Roux-en-Y anastomosis is one of the most difficult steps.