Mei Diao1, Long Li2, Wei Cheng3,4,5. 1. Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People's Republic of China. 2. Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People's Republic of China. lilong22@hotmail.com. 3. Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People's Republic of China. wei.cheng@monash.edu. 4. Department of Paediatrics and Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia. wei.cheng@monash.edu. 5. Department of Surgery, Beijing United Family Hospital, Beijing, China. wei.cheng@monash.edu.
Abstract
BACKGROUND: Conventionally, perforated choledochal cyst (CDC) is a contraindication of laparoscopic treatment. The current study is to evaluate efficacy of single-incision laparoscopic hepaticojejunostomy (SILH) in children with perforated CDCs. METHODS: One hundred and thirty-three children with perforated CDCs who underwent SILHs in our hospital between August 2011 and August 2017 were reviewed. RESULTS: Fifteen (11.3%) patients were converted to open procedures due to severe adhesions and oozing. The mean age at SILH was 2.09 years (range 2 days-12.37 years). The average operative time was 3.23 h (range 2-5 h). The mean postoperative hospital stay was 6.25 days (range 4-16 days). The mean time to full diet resumption was 2.18 days (range 2-6 days). The mean duration of drainage was 3.71 days (range 3-10 days). The median follow-up period was 24 months. Postoperative liver function tests and serum amylase levels returned to normal within 1 year. Three (2.5%) patients required blood transfusions because of extensive oozing from intramural micro-vessels of CDCs. Two (1.7%) patients encountered duodenal injuries because of severe adhesions. The duodenum was repaired with double-layer 5-0 PDS running sutures. One (0.8%) patient with giant CDC had abdominal fluids because of extensive dissection of intrapancreatic segment of CDC. He recovered after 10 days of drainage. None of patients had bile leak, anastomotic stenosis, cholangitis, intrahepatic reflux, pancreatic leak, pancreatic calculi formation, pancreatitis, Roux-loop obstruction, or adhesive intestinal obstruction. CONCLUSIONS: Single-incision laparoscopic hepaticojejunostomy is safe and effective for selected patients with perforated CDCs in experienced hands.
BACKGROUND: Conventionally, perforated choledochal cyst (CDC) is a contraindication of laparoscopic treatment. The current study is to evaluate efficacy of single-incision laparoscopic hepaticojejunostomy (SILH) in children with perforated CDCs. METHODS: One hundred and thirty-three children with perforated CDCs who underwent SILHs in our hospital between August 2011 and August 2017 were reviewed. RESULTS: Fifteen (11.3%) patients were converted to open procedures due to severe adhesions and oozing. The mean age at SILH was 2.09 years (range 2 days-12.37 years). The average operative time was 3.23 h (range 2-5 h). The mean postoperative hospital stay was 6.25 days (range 4-16 days). The mean time to full diet resumption was 2.18 days (range 2-6 days). The mean duration of drainage was 3.71 days (range 3-10 days). The median follow-up period was 24 months. Postoperative liver function tests and serum amylase levels returned to normal within 1 year. Three (2.5%) patients required blood transfusions because of extensive oozing from intramural micro-vessels of CDCs. Two (1.7%) patients encountered duodenal injuries because of severe adhesions. The duodenum was repaired with double-layer 5-0 PDS running sutures. One (0.8%) patient with giant CDC had abdominal fluids because of extensive dissection of intrapancreatic segment of CDC. He recovered after 10 days of drainage. None of patients had bile leak, anastomotic stenosis, cholangitis, intrahepatic reflux, pancreatic leak, pancreatic calculi formation, pancreatitis, Roux-loop obstruction, or adhesive intestinal obstruction. CONCLUSIONS: Single-incision laparoscopic hepaticojejunostomy is safe and effective for selected patients with perforated CDCs in experienced hands.
Entities:
Keywords:
Children; Choledochal cysts; Hepaticojejunostomy; Perforation; Single-incision laparoscopic surgery
Authors: Simon Nennstiel; Andreas Weber; Günter Frick; Bernhard Haller; Alexander Meining; Roland M Schmid; Bruno Neu Journal: J Clin Gastroenterol Date: 2015-10 Impact factor: 3.062