Abstract
BackgroundTo present a modified laparoscopic surgical technique that works to optimize the surgical view in laparoscopic total excision of choledochal cyst in pediatric patients.MethodsFrom June 2015 to June 2017, a total of 48 pediatric cases of choledochal cyst were admitted. Their age ranged from 15 month to 8 years (average 3.5 years). The Todani types were: type I (n = 32) and type IVa (n = 16), according to the diagnostic criteria of ultrasound, abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP).ResultsTotal cystic excision with hepaticoenterostomy was accomplished laparoscopically in 48 cases with our transumbilical single -incision method without conversion to open surgery. Average duration of operation was 200 min (range 170–240 min), average intraoperative blood loss was 9 ml (range 6–14 ml) without the need for blood transfusion. The 72-h postoperative ultrasound reported no abdominal effusion, when the intraperitoneal drainage tube was removed. There was no postoperative complication during the 6 months of follow-up.ConclusionsWe accomplished the same postoperative outcome in laparoscopic total cyst excision with our modified method as that with conventional laparoscopic surgery. This technique allows the operator to have a stabilized surgical view without needing to rely on an assistant to hold up the liver lobe for larger operative space.
Highlights
To present a modified laparoscopic surgical technique that works to optimize the surgical view in laparoscopic total excision of choledochal cyst in pediatric patients
Since Farello et al [1] first reported laparoscopic surgery for choledochal cyst (CC) excision in 1995, minimally invasive surgery has been increasingly used in the surgical intervention of CCs, which are congenital disorders manifested as cystic dilatation of the biliary ducts
Since 2015, we have adapted to laparoscopic CC excision in our pediatric department using a modified transumbilical single-incision method, and achieved satisfactory postoperative outcome
Summary
To present a modified laparoscopic surgical technique that works to optimize the surgical view in laparoscopic total excision of choledochal cyst in pediatric patients. Since Farello et al [1] first reported laparoscopic surgery for choledochal cyst (CC) excision in 1995, minimally invasive surgery has been increasingly used in the surgical intervention of CCs, which are congenital disorders manifested as cystic dilatation of the biliary ducts. The standard approach in open surgery for CC treatment includes total cyst excision and Rouxen-Y hepaticoenterostomy, preferably hepaticojejunostomy [3]. In China, laparoscopic total cyst excision with Roux-en-Y hepaticojejunostomy was first reported in the laparoscopic surgery for cyst excision is a technically challenging procedure and largely depends on the experience of the surgeon.
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