Mei Diao1, Long Li2, Wei Cheng3. 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 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.
Abstract
BACKGROUND: The aim of the current study is to evaluate efficacy of laparoscopic treatment for aberrant hepatic duct (AHD) in children with cholecochal cysts (CDC). METHODS: CDC children with AHDs who successfully underwent laparoscopic ductoplasties and hepaticojejunostomies between October 2001 and October 2017 were reviewed. The AHD variations were categorized into four subtypes and the surgical management varied according the subtypes. RESULTS: Sixty CDC patients with AHDs were reviewed. The mean age at surgery was 3.91 years. Two patients with Type 2 anomaly developed bile leaks after primary surgeries, and underwent laparoscopic anastomosis of AHD to jejunum in redo surgeries. In the remaining 58 patients, the average operative time was 3.75 h. The mean postoperative hospital stay was 6.02 days. The mean duration for full diet resumption was 2.25 days. The mean drainage time was 4.05 days. The median follow-up period was 30 months. Two patients with giant cysts had fluid collections, and were cured by drainages. One patient encountered duodenal injury at perforation site, and underwent laparoscopic repair. None of the patients had anastomotic stenosis, bile leak, cholangitis, intrahepatic reflux, pancreatic leak, pancreatitis, Roux-loop obstruction, or adhesive intestinal obstruction. Postoperative liver function tests and serum amylase level normalized within 1 year. CONCLUSIONS: Recognition and treatment based on different subtypes of AHDs effectively prevent relevant complications. Individualized laparoscopic ductoplasty and hepaticojejunostomy is an efficacious management for AHDs in CDC children.
BACKGROUND: The aim of the current study is to evaluate efficacy of laparoscopic treatment for aberrant hepatic duct (AHD) in children with cholecochal cysts (CDC). METHODS: CDC children with AHDs who successfully underwent laparoscopic ductoplasties and hepaticojejunostomies between October 2001 and October 2017 were reviewed. The AHD variations were categorized into four subtypes and the surgical management varied according the subtypes. RESULTS: Sixty CDC patients with AHDs were reviewed. The mean age at surgery was 3.91 years. Two patients with Type 2 anomaly developed bile leaks after primary surgeries, and underwent laparoscopic anastomosis of AHD to jejunum in redo surgeries. In the remaining 58 patients, the average operative time was 3.75 h. The mean postoperative hospital stay was 6.02 days. The mean duration for full diet resumption was 2.25 days. The mean drainage time was 4.05 days. The median follow-up period was 30 months. Two patients with giant cysts had fluid collections, and were cured by drainages. One patient encountered duodenal injury at perforation site, and underwent laparoscopic repair. None of the patients had anastomotic stenosis, bile leak, cholangitis, intrahepatic reflux, pancreatic leak, pancreatitis, Roux-loop obstruction, or adhesive intestinal obstruction. Postoperative liver function tests and serum amylase level normalized within 1 year. CONCLUSIONS: Recognition and treatment based on different subtypes of AHDs effectively prevent relevant complications. Individualized laparoscopic ductoplasty and hepaticojejunostomy is an efficacious management for AHDs in CDC children.
Authors: Long Li; Wang Feng; Fu Jing-Bo; Yu Qi-Zhi; Liu Gang; Huang Liu-Ming; Lei Yu; Jia Jun; Wang Ping Journal: J Pediatr Surg Date: 2004-11 Impact factor: 2.545