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
OBJECTIVE: Hepatic cysts with biliary communications (HC) and cystic dilatations of main intrahepatic ducts (CIHD) can cause biliary obstruction, cholestasis, stone formation, cholangitis, liver damage and carcinoma. Conventionally, Roux-Y cysto-jejunostomy is employed to manage these conditions. However, it is technically demanding and may be complicated with major biliary disruption and bacteria migration from intestine to intrahepatic duct. We have carried out laparoscopic cysto-cholecystostomies for HC with biliary communication and CIHD and evaluated outcomes. METHODS: Twenty patients with HC (n = 10) or CIHD (n = 10) who successfully underwent laparoscopic cysto-cholecystostomies in our center, between September 2010 and March 2017, were reviewed. RESULTS: The mean age of the patients at surgery was 2.06 and 2.23 years for HC and CIHD groups, respectively. Eighteen patients were symptomatic, with abdominal pain, fever, vomiting and jaundice. Laboratory results showed abnormal liver functions in 8 patients. Pathological results verified hepatic cellular damages in 8 patients. The mean operative time was 0.97 and 0.92 h for HC and CIHD patients, respectively. The median follow-up duration was 27 months (1-54 months) and 35 months (1-79 months) for HC and CIHD groups, respectively. No patient developed bile leak, anastomotic stenosis, stone formation or cholangitis. Liver function normalized postoperatively. CONCLUSIONS: Laparoscopic cysto-cholecystostomy is a simpler and more physiological surgical alternative for managing HC with biliary communication and CIHD.
OBJECTIVE: Hepatic cysts with biliary communications (HC) and cystic dilatations of main intrahepatic ducts (CIHD) can cause biliary obstruction, cholestasis, stone formation, cholangitis, liver damage and carcinoma. Conventionally, Roux-Y cysto-jejunostomy is employed to manage these conditions. However, it is technically demanding and may be complicated with major biliary disruption and bacteria migration from intestine to intrahepatic duct. We have carried out laparoscopic cysto-cholecystostomies for HC with biliary communication and CIHD and evaluated outcomes. METHODS: Twenty patients with HC (n = 10) or CIHD (n = 10) who successfully underwent laparoscopic cysto-cholecystostomies in our center, between September 2010 and March 2017, were reviewed. RESULTS: The mean age of the patients at surgery was 2.06 and 2.23 years for HC and CIHD groups, respectively. Eighteen patients were symptomatic, with abdominal pain, fever, vomiting and jaundice. Laboratory results showed abnormal liver functions in 8 patients. Pathological results verified hepatic cellular damages in 8 patients. The mean operative time was 0.97 and 0.92 h for HC and CIHD patients, respectively. The median follow-up duration was 27 months (1-54 months) and 35 months (1-79 months) for HC and CIHD groups, respectively. No patient developed bile leak, anastomotic stenosis, stone formation or cholangitis. Liver function normalized postoperatively. CONCLUSIONS: Laparoscopic cysto-cholecystostomy is a simpler and more physiological surgical alternative for managing HC with biliary communication and CIHD.
Authors: S Suzuki; K Kurachi; Y Yokoi; Y Tsuchiya; K Okamoto; T Okumura; K Inaba; H Konno; S Nakamura Journal: J Hepatobiliary Pancreat Surg Date: 2001