Early complications after laparoscopic resection of choledochal cyst

Bing Zhang,Yifan Fang,Jianxi Bai,Jiancai Chen,Le Li,Mingkun Liu,Wenhua Huang,Dianming Wu

doi:10.1007/s00383-019-04489-y

Abstract

PurposeTo investigate the causes and treatments of early complications involving laparoscopic radical resection of choledochal cyst and summarize the experience.MethodsChildren with choledochal cyst treated by laparoscopy in the Department of Pediatric Surgery, Fujian Provincial Maternity and Children’s Hospital, and Guangzhou Women and Children’s Medical Centre, from March 2016 to May 2018, were retrospectively analysed. Demographics, causes and treatments of early complications, liver function analysis and ultrasonography were collected.ResultsIn total, 231 cases were included; 204 were Type I (156 Type Ia and 46 Type Ic) and 27 were Type IV. No mortality was observed, and 224 cases were successfully laparoscopically operated, while 7 cases were converted to open surgery. Fifteen cases of postoperative developed biliary fistula. There were jejunal Roux loop obstruction in 2 cases and multiple intussusception, anastomotic stenosis after hepaticojejunostomy, residual of choledochal cyst and pancreatic fistula in one each. Patients were followed up ranging from 4 months to 48 months (12.6 ± 0.3 months on average). Postoperative ALT, AST, GGT, TBIL and DBIL all returned to normal during this time. Ultrasonography indicated 5 cases of widened Glisson’s sheath and 1 case of intrahepatic hyperdense shadow.ConclusionEarly complications of laparoscopic radical resection of choledochal cyst can be minimized by properly managing preoperative indications and contraindications, carefully interpreting the magnetic resonance cholangiopancreatography results and accumulating experience by the surgeons.

Highlights

Choledochal cyst frequently occurs in Asian, mainly in girls, and 80% of patients have their onset in childhood
The purpose of this study is to analyse the causes of early complications after laparoscopic resection of choledochal cyst and summarize the experience of treatments
This study presents a retrospective review of paediatric patients with choledochal cyst treated by laparoscopy in the Department of Pediatric Surgery, Fujian Provincial Maternity and Children’s Hospital, and Guangzhou Women and Children’s Medical Centre, from March 2016 to May 2018

Summary

Introduction

Choledochal cyst frequently occurs in Asian, mainly in girls, and 80% of patients have their onset in childhood. Infants and younger children often demonstrate painless jaundice, while older children have recurrent abdominal pain [1]. It is a common disease in departments of paediatric surgery. With the development of imaging techniques and the prenatal screening, an increasing number of asymptomatic cases have been diagnosed [2]. The cyst can lead to recurrent symptoms and malignant transformation.

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