Efficacy ofcombined-laparoscopic-ureteroscopic procedure for precise resection of type I choledochal cyst in children

Abstract

Objective To summarize the institutional experiences of combined-laparoscopic-ureteroscopic procedure (CLUP) for resecting type I choledochal cyst (CC) in children. Methods A recent series of 17 cases of type I CC undergoing CLUP from November 2016 to May 2017 (group A) was compared with 66 CC patients undergoing traditional laparoscopy between November 2013 and September 2016 (group B). Laparoscopic excision of CC was performed along with a fine neonatal ureteroscopic (Storz, 7F). The clinical data of operative duration, intraoperative bleeding, CC resection, postoperative pancreatitis and cholangitis were analyzed. Results No inter-group difference existed in operative duration or intraopeartive bleeding. Fifteen patients in group A and 55 cases in group B were followed up until November 2017. In group A, intrapancreatic choledochal cyst (IPCC) was measured accurately by a 7F neonatal ureteroscopy and precisely dissected without any complication. Postoperative magnetic resonance imaging (MRI) scans showed no distal IPCC residue in 11 patients of group A. However, two cases of group B had IPCC residue confirmed MRI or ultrasound and one child was re-operated. There were neither postoperative pancreatitis nor cholangitis in group A. Yet postoperative pancreatitis (5.4%, 3/55) and cholangitis (3.6%, 2/55) occurred in group B. Conclusions CLUP is capable of safely improving the outcomes, aiding precise total CC excision and lowering the incidence of postoperative pancreatitis and cholangitis. Key words: Choledochal cyst; Ureteroscopic; Laparoscopic; Child