Laparoscopic Choledochal Cyst Excision Research Articles

Comparative study of robotic-assisted single-incision-plus-one port and single-incision laparoscopic choledochal cyst excision

ObjectiveTo compare the efficacy of robotic-assisted single-incision-plus-one-port laparoscopic choledochal cyst excision (R-SILC + 1) and single-incision laparoscopic choledochal cyst (SILC) in treating pediatric choledochal cyst (CDC).MethodsWe retrospectively analyzed the clinical data of patients diagnosed with CDC in our hospital from June 2021 to October 2023. Among them, patients underwent either R-SILC + 1 or SILC procedures. Demographic parameters, operative details, and postoperative outcomes were studied.ResultsA total of forty-nine patients were included, with 23 children undergoing R-SILC + 1 and 26 children undergoing SILC. There were no statistically significant differences in demographic data, postoperative pain scores, and postoperative complication rates between the two groups (all p > 0.05). Compared with the SILC group, the R-SILC + 1 group demonstrated less intraoperative bleeding volume (10.4 ± 3.6 vs. 15.0 ± 3.6 ml, p < 0.05), a shorter indwelling time of the abdominal drainage tube [5(5,6) vs. 7(5.8,8.3) d, p < 0.05], a shorter postoperative fasting time [4(3,4) vs. 6(5,7) d, p < 0.05], and a shorter postoperative discharge time [6(6,7) vs. 8(6,11) d, p < 0.05]. However, the R-SILC + 1 group had a longer operation time [388(295,415) vs. 341(255.8,375.2) min, p < 0.05] and higher hospitalization cost (7.9 ± 0.4 vs. 3.2 ± 0.3 ten thousand, p < 0.05).ConclusionCompared with the SILC group, the R-SILC + 1 group demonstrated clear advantages in treating pediatric CDC, but it is associated with a prolonged learning curve and operation time, and high costs. With improvements in physician experience and technological advancements, its potential will be further unleashed.

Laparoscopic choledochal cyst excision and biliary reconstruction in patients with previous surgery/ intervention: Feasibility and outcome.

The aim of the study was to evaluate the feasibility and outcome of laparoscopic surgery in complicated choledochal cyst (CDC) with previous interventions (laparotomy or biliary drainage). Patients with CDC who underwent surgery from July 2014 to July 2019 were evaluated. CDC without previous interventions (Group A) was compared with CDC that had previous interventions (Group B) to assess the feasibility and outcome of laparoscopic surgery. In 5 years' period, 38 patients were operated for CDC. The mean age was similar in both groups (3.78 ± 2.27 in Group A and 4.08 ± 2.73 in Group B). Out of six CDC with previous intervention (Group B), five patients were previously managed at other institutions as follows: (1) Laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) stenting. (2) Laparotomy for biliary peritonitis and ERCP. (3) Percutaneous drainage of the large cyst. (4) Laparoscopic cholecystectomy. (5) ERCP stenting. (6) Percutaneous drainage for biliary ascites. All patients underwent laparoscopic CDC excision and hepatico-duodenostomy. The mean duration of surgery was 160.3 ± 17.22 in Group A and 169.2 ± 17.5 in Group B ( P = 0.258). None required intraoperative blood transfusion. None had a bile leak. Drain was removed at 4.47 ± 0.98 in Group A, while at 4.17 ± 0.75 days in Group B ( P = 0.481). There was statistically no significant difference in feed starting time or length of stay. In follow-up of 6 months-3 years, all patients are asymptomatic. Laparoscopy in complicated CDC with previous intervention is technically tedious but is feasible. The procedure is safe and delivers a good outcome.

Laparoscopic excision versus open excision for the treatment of choledochal cysts: a systematic review and meta-analysis

To determine if laparoscopic excision is more effective than open excision in the treatment of choledochal cysts. A systematic review of randomized clinical trials in 3 databases measuring the efficacy of laparoscopic and open excision of choledochal cysts was performed. The authors considered international and national reports, whose results were analyzed in detail. Mean duration of laparoscopic excision was 51 min, open excision - 35.4 min. Length of hospital-stay after laparoscopic excision ranged between 5 and 74 days, after open excision - between 7 and 146 days. Bile leakage rate was 1-2% and 4%, respectively. Laparoscopic excision was followed by lower complication rate. Morbidity and mortality in laparoscopic excision was 20% and 0%, in open excision - 60% and 3.3%, respectively. Laparoscopic excision is more effective than open excision in the treatment of choledochal cysts.

The impact of pre-operative cholecystostomy on laparoscopic excision of choledochal cyst in paediatric patients.

This aim of this study was to identify the pre-operative risk factors for conversion during laparoscopic excision of choledochal cyst in paediatric patients. A retrospective single-centre study was carried out. All paediatric patients (< 18years) who had undergone laparoscopic excision of choledochal cyst between 2004 and 2021 were reviewed. The outcome was conversion to open surgery and pre-operative factors that affected the conversion rate were analyzed. Sixty-one patients were included. Conversion was required in 24 cases (39.3%). There was no difference in the conversion rate between the first (before 2012, n = 30) and second (after 2012, n = 31) half of the series (36.7% vs. 42.0%, p = 0.674). Majority was type 1 cyst (86.8%) and the median cyst size was 4.6cm (IQR: 2.2-6.4cm). Antenatal diagnosis was available in 18 patients (29.5%). The median age at operation was 23.0months (IQR: 8.0-72.0months). Pre-operatively, 19 patients (31.1%) suffered from cholangitis and 5 (8.2%) of them required cholecystostomy. Comparing patients with successful laparoscopic surgery (L) and converted cases (C), there were no differences in the age at operation (p = 0.74), cyst size (p = 0.35), availability of antenatal diagnosis (p = 0.23) and cholangitic episodes (p = 0.40). However, a higher percentage of patients required cholecystostomy in the converted group (L vs. C = 2.7% vs. 16.7%, p = 0.05). Using logistic regression analysis, it was also a risk factor for conversion (OR = 3.5 [1.37-5.21], p = 0.05). Pre-operative cholecystostomy is a potential risk factor for conversion during laparoscopic excision of choledochal cyst in children.

Laparoscopic excision of choledochal cysts: expect the unexpected

Laparoscopic excision of choledochal cysts: expect the unexpected

Initial experience with 3D laparoscopic choledochal cyst (CDC) excision and hepatico-duodenostomy (HD) in 21 children.

Minimal access surgery has gradually become the standard of care in the management of choledochal cysts (CDC). Laparoscopic management of CDC is a technically challenging procedure that requires advanced intracorporeal suturing skills, and hence, has a steep learning curve. Robotic surgery has the advantages of 3D vision, articulating hand instruments making suturing easy and thusis ideal. However, the non-availability, high costs and necessity for large-size ports are the major limiting factors for robotic procedures in the paediatric population. Use of 3D laparoscopy incorporates the advantage of 3D vision and at the same time allows the use of small-sized conventional laparoscopic instruments. With this background, we discuss our initial experience with the use of 3D laparoscopy using conventional hand instruments in CDC management. To study our initial experience in the management of CDC in paediatric patients with 3D laparoscopy in terms of feasibility and peri-operative details. All patients under 12years of age treated for choledochal cyst in a period of initial 2years were retrospectively analysed. Demographic parameters, clinical presentation, intra-operative time, blood loss, post-operative events and follow-up were studied. The total number of patients were 21. The mean age was 5.3years with female preponderance. Abdominal pain was the most common presenting symptom. All patients could be completed laparoscopically. No patient needed conversion to open procedure or re-exploration. The average blood loss was 26.67ml. None of the patients required a blood transfusion. One patient developed a minor leak postoperatively and was managed conservatively. 3D laparoscopic management of CDC in the paediatric age group is safe and feasible. It offers the advantages of depth perception aiding intracorporeal suturing, with the use of small-sized instruments. It is thus a 'bridging the gap' asset between conventional laparoscopy and robotic surgery. Treatment study level IV.

Modified single-port versus multiport laparoscopic choledochal cysts excision and Roux-en-Y hepaticojejunostomy: a retrospective comparative cohort study.

The feasibility, benefit, and safety of multiport laparoscopic choledochal cyst (CDC) excision and Roux-en-Y hepaticoenterostomy (MPCH) have been consistently confirmed. Single-port laparoscopic CDC excision and Roux-en-Y hepaticoenterostomy (SPCH) has advantages of less traumatic and more cosmetic beneficial, it has been reported in some case series, but it is technically challenging. We propose a modified technique to reduce technical difficulty in performing SPCH. The safety and feasibility of modified SPCH were compared with those of conventional multiport laparoscopic CDC excision. A total of 43 consecutive patients who diagnosed with CDC by preoperative magnetic resonance cholangiopancreatography (MRCP) and underwent SPCH (n=24) and MPCH (n=19) for choledochal cyst (CDC) by a single surgeon between January 1, 2018, and January 1, 2021, were enrolled. The baseline clinical characteristics, efficacy and safety outcomes of short-term were compared. The baseline clinical characteristics of the MPCH and SPCH groups are comparable. Average postoperative length of hospital stay was shorter in the SPCH group than in the MPCH group, but the difference was not statistically significant (7.00 vs. 7.58 days; P>0.99). The operation time (281.75 vs. 277.3 min; P=0.58) and the amount of blood loss (9.33 vs. 16.68 mL; P=0.57) were similar in both groups. A significantly greater number of drainage tubes were placed in the MPCH group compared to the SPCH group (11 vs. 5; P=0.01). One patient suffered from hepaticoenterostomy anastomosis stricture in the SPCH group. The short-term outcome of modified SPCH is comparable with MPCH according to our study. It is easily adaptable treatment of CDC.

Laparoscopic excision of a giant choledochal cyst in a 5-year-old child

Laparoscopic excision of a giant choledochal cyst in a 5-year-old child

How we acquire suturing skills for laparoscopic hepaticojejunostomy

Laparoscopic choledochal cyst excision and hepaticojejunostomy is a representative surgical procedure requiring laparoscopic suturing including needle driving and knot tying. Laparoscopic needle driving and knot tying is a highly technically demanding skill, especially in small infants and children. We developed a laparoscopic hepaticojejunostomy simulator for training. This simulator was developed for a 1-year-old infant body size based on computed tomography data and reproduced a pneumoperitoneum condition based on 3D scanner data of the clinical situation. Surgeon in training (SITs) of our institution have to acquire practice of laparoscopic hepaticojejunostomy using a simulator before performing clinical cases. Thirteen cases of choledochal cyst have been managed at our institution since the introduction of practice using this simulator in 2016. Six SITs performed 13 cases of laparoscopic choledochal cyst excision and hepaticojejunostomy. There were no cases of anastomotic bile leakage. Laparoscopic disease-specific simulator practice is effective for the acquisition of secure hepaticojejunostomy skills for the treatment of choledochal cysts in children as off-the-job training.

Laparoscopic hepaticoduodenostomy for choledochal cysts in children

Context:Choledochal cyst (CHC) is one of the most common causes of surgical jaundice in infants. In 1955, Farello et al. were the first to introduce the laparoscopic approach for treatment of CHC.Aim of the Study:Minimally invasive approaches to the management of CHC excision have been done in pre-schoolers and above but have not yet been described in toddlers, let alone infants. Herein, we review the results of 10 consecutive children <1 year managed with laparoscopic CHC excision and hepaticoduodenostomy.Methods:This retrospective study investigated 10 infants who underwent laparoscopic resection of a CHC with creation of a hepaticoduodenostomy.Results:This study was performed on 10 consecutive patients <1 year. Liver fibrosis was found in 4 patients. We had 7 cases with Type 1 CHCs and 3 cases with Type IV A cysts. Total cyst excision was done in all patients, no cases needed blood transfusion and the mean operative time was 200 min. The mean hospital stay was 6 days. Overall, morbidity occurred in 20% of the cases presenting with bouts of cholangitis that resolved without any intervention, once at 6 months, the other at 1-year post-operative. There were neither anastomotic strictures nor biliary fistula formation; magnetic resonance cholangiopancreatography was done to these two cases revealed no stricture and mortality at 30 and 90 days was nil.Conclusion:Laparoscopic hepaticoduodenostomy in CHC in children <1 year is safe, with satisfactory short-term results.

Laparoscopic excision of congenital choledochal cyst in children and modified hepaticojejunostomy with an unequal length of the jejunal loop

Introduction: Complete excision biliary-enteric reconstruction is necessary for a congenital choledochal cyst (CC) to prevent recurrent cholangitis, acute pancreatitis, and cholangiocarcinoma. Among various reconstructions, this study aims to evaluate the therapeutic effect of unequal length jejunal loop for the biliary reconstruction of congenital choledochal cyst.&#x0D; Method: The clinical data of 56 cases of congenital choledochal cyst treated in the pediatric surgery department of Children's Hospital Affiliated to Zheng Zhou University were retrospectively analyzed. All cases were treated with choledochal cyst resection and unequal length jejunal loop biliary reconstruction, including 51 cases with laparoscopic surgery and 5 cases with traditional surgery.&#x0D; Result: Choledochal cyst resection and unequal length jejunal loop biliary reconstruction were successfully completed in all cases. One case of laparoscopic operation developed biliary fistula on the 3rd day after the operation, and the biliary fistula healed after conservative treatment for 8 days. The other cases recovered smoothly without obvious complications. No contrast agent bile loop reflux was found in upper gastrointestinal angiography.&#x0D; Conclusion: The modified jejunal loop biliary reconstruction has many advantages over the traditional biliary reconstruction, which is worthy of clinical application.

Modified Laparoscopic Excision of Choledochal Cyst: Technique and Early Results.

Background:Choledochal cyst is a common congenital anomaly requiring surgical treatment. Nowadays, laparoscopic excision is the preferred approach. We studied a modification in the classical laparoscopic approach to facilitate the dissection of a cyst.Materials and Methods:A prospective comparative study was done on 42 Type I choledochal cyst children. One group was operated by classical laparoscopic technique, while the other group was operated by modification of classical technique by deliberately opening the cyst wall and dividing the cyst into two hemi-cups, followed by dissection and excision. The intraoperative and postoperative parameters were assessed in both the groups.Results:The age, gender ratio, clinical presentation, and cyst diameter were comparable in both the groups. There was a significantly higher success rate (95.7% vs. 73.7%, P = 0.042) and lesser time for cyst excision (96.43 ± 12.15 vs. 120.91 ± 17.38 min P < 0.001) in the modified technique when compared to the classical technique. Further in three patients, it was possible to convert the classical procedure to a modified technique and complete the cyst excision. The postoperative outcomes were similar in both the groups.Conclusion:The modified laparoscopic excision shortens the operative time with higher success rate and comparable short-term morbidity vis-a-vis classical laparoscopic technique.

Comparison of long-term biliary complications between open and laparoscopic choledochal cyst excision in children.

PurposeCyst excision with hepaticojejunostomy has been the classic procedure for treating choledochal cysts, and the use of laparoscopic treatment has been favored recently. The purpose of this study was to compare the long-term biliary complication of laparoscopic operation with open surgery for choledochal cyst presenting in children.MethodsA retrospective study comparing the laparoscopic and open procedures was performed in 185 patients with choledochal cyst in a single children's hospital. There were 109 patients who were operated with open surgery, and 76 patients operated with laparoscopic surgery. The primary outcome was long-term biliary complications and the secondary outcome included operative time, intraoperative transfusion, length of hospital stay, and other late postoperative complications.ResultsIn the patient's demographics, there was no significant difference between the 2 groups. Notably, it was shown that the operative time was longer in the laparoscopic group. The number of patients requiring blood transfusion intraoperatively was lower in the laparoscopic group. It was noted that the hospital stay was not statistically different. The duration to resumption of diet and duration of drainage were longer in the laparoscopic group. Biliary complications were shown to be significantly higher in the open group. The risk factor for long-term biliary complications was noted with the intraoperative transfusion.ConclusionThe use of a laparoscopic choledochal cyst excision with hepaticojejunostomy is a safe and feasible technique in a young patient. The long-term biliary complication was lower compared to open surgery, rendering this a good option for pediatric patients.

Laparoscopic Type IV Choledochal Cyst Excision with Roux-En-Y Hepaticojejunostomy

Introduction: Choledochаl cysts represent а rare congenital cystic dilation of the biliary tract. Nearly 25% are diagnosed in the first year of life with and incidence of approximately 1/200 000 live births in western countries, although these numbers are significantly higher in East Аsiаn populations. Presentation typically occurs in childhood, with jaundice, fever or an abdominal mass. Although benign, choledochаl cysts cаn be аssociаted with various complications including malignant transformation. In western countries, the incidence of cholangiocarcinoma has been reported to reach 12% in some series, with higher reports in Asian countries. Other hurdles include cholangitis, pancreatitis, and cholelithiаsis. The modified Todani classification is employed to describe the various types of choledocal cysts (I-V). Type I, a fusiform dilation of the common bile duct, is the most common. Type IV is the second most prevalent, with extension of the cysts into the intrahepatic ducts. Types II, II and V are less frequent. This video intends to present the laparoscopic excision of a type IV choledocal cyst with intracorporeal Roux-en-Y hepaticojejunostomy with a specific attention on technical detail and education. Methods: A 49 year old female with no relevant prior medical history presented with a history of abdominal comfort. Results: An abdominal CT scan showed common biliary duct dilation and an MRi revealed the existence of a type IVa choledochаl cyst. Laparoscopic cyst excision was proposed and accepted. The patient was submitted to surgery on January 2021, initiated oral intake on day 2 and was discharged at day 7 without any hurdles. Conclusion: Laparoscopic choledochal cyst excision is a safe procedure with decreased morbidity and in-hospital stay days compared with an open approach. The authors consider that the video quality and surgical procedure can successfully contribute to the education and training of surgery residents and also contribute to share expertise and consolidate knowledge to surgeons.

Laparoscopic excision of choledochal cyst with Roux-en-Y hepaticojejunostomy

Presenter: Domenech Asbun MD | Mayo Clinic, Florida Background: Choledochal cysts are rare congenital abnormalities that result in cystic dilations of the bile ducts. They harbor potential for complications including cholangitis and malignant degeneration to cholangiocarcinoma. They are treated with surgical excision. Methods: We performed a laparoscopic excision of a large choledochal cyst involving the entire common hepatic and common bile duct. The patient is a 19 year old female. An intraoperative video recording of the operation is presented. Results: The cyst was successfully excised in its entirety through a laparoscopic approach. Biliary tract continuity is re-established through a Roux-en-Y hepaticojejunostomy, also performed laparoscopically. The case lasted approximately four and a half hours, with 100 mL of blood loss. Conclusion: Laparoscopic surgical excision of choledochal cysts with biliary reconstruction is safe and feasible. We demonstrate our approach to the procedure in a young patient with a large cyst.

Is the laparoscopic choledochal cyst excision and Roux-En-Y hepaticojejunostomy in adults as safe as that in children?

АbstrаctBаckgrоundLaparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for treating congenital choledochal cysts has been proven to be efficacious in children, but its safety and efficacy in adult patients remain uncertain. This study aims to investigate the safety and effectiveness of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in adults compared to those in children patients.ResultsThere was no conversion to open surgery in both groups. The mean operative time and hospital duration stay in adults (253.4 min and 11.7 days, respectively) were longer in than those in children (214.7 min and 9.3 days, respectively). Intrаоperаtive blооd trаnsfusiоn wаs required in one adult and twо children. There was not reoperation due to bile leakage in adults compared to those in 2 children. The time frоm surgery tо drаinаge remоvаl wаs longer in adults (3.6 vs. 2.9 days). The outcome within three months of discharge was classified as good in 88.2 % of adults and 90.5% for children. There were nо stаtisticаlly significаnt differences in eаrly pоstоperаtive cоmplicаtiоns оr treаtment оutcоmes between the twо grоups.CоnclusiоnsLаpаrоscоpic chоledоchаl cyst excisiоn fоllоwed by Rоux-en-Y hepаticоjejunоstоmy wаs sаfe аnd efficient in bоth аdults аnd children. Оperаtive time wаs lоnger in аdults thаn in children.

Comparison of outcomes of laparoscopic choledochal cyst excision and roux-en-y hepaticojejunostomy between children and adults

Abstract Introduction: The aim of this study is to compare the outcomes of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy between adults and children Material and Methods: A prospective study of 19 adults and 51 children with choledochal cyst treated by laparoscopic surgery at Hue Central Hospital from 1/2012 to 12/2017. Results: The average operative time was 219.79 ± 64.88 minutes. The average operative time in adults was longer than in children (233.42 vs 219.79 minutes). There was a statistically significant difference between two groups. Intraoperative blood transfusion was required in two patients in children group. The time from surgery to drainage removal was shorter in adults (2.89 vs 3.57 days). Postoperative follow-up results after 10 days to 3 months were classified as good and fair. There were no statistically significant differences in early postoperative complications, treatment outcomes between two groups. Conclusion: Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was safe and efficient in both adults and children. Operative time was longer in adults than in children.

WITHDRAWN: Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy: A comparative study between children and adults

WITHDRAWN: Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy: A comparative study between children and adults

Laparoscopic resection of choledochal cysts in adults: a series from Turkey.

Choledochal cyst is a congenital disease in which surgical treatment is preliminary because of the potential for malignancy. In recent years, increase in technological developments and laparoscopic experience have popularised the use of laparoscopy in adult choledochal cyst surgery. This study aimed to present the results of eight adult patients undergoing laparoscopic choledochal excision surgery. Patients who underwent laparoscopic choledochal cyst excision and hepatico-jejunostomy anastomoses between the years 2013 and 2018 were evaluated retrospectively. Demographic characteristics, preoperative and postoperative findings, pathological results and final condition of the patients were examined. Of the eight patients, three were males and five were females. Median age was 41.5 years (22-49). One of the patients had Type IVa and the rest had Type I choledochal cysts. Laparoscopic choledochal cyst excision, cholecystectomy, and hepatico-jejunostomy anastomoses were performed on all of the patients. One patient was converted to open surgery. Three patients had postoperative biliary leakage. Duration of the operations was determined as median 330 (240-480) minutes and blood loss was 50 (10-100) mL. Hospitalization of the patients was median 6 (4-23) days and follow-up time was median 20 (2-65) months. In the late period, cholangitis occured in a patient who was treated with medical therapy and there was no mortality in the follow-up period. We suggest that laparoscopic choledochal cyst excision in adults may be an alternative to open surgery due to the satisfactory results in the late period in spite of early problems like self-limiting bile leakage.

Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: a single-institution prospective cohort study

Background: Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy is gaining popularity as a treatment for choledochal cyst in children. The aim of this study is to determine the feasible and safe of the laparoscopic excision with Roux-en-Y hepaticojejunostomy, and evaluate the short-term outcomes after treatment for children with choledochal cyst.Methods: A prospectively of 51 consecutive pediatric patients undergoing laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy performed by one surgeon cysts at Hue Central Hospital from June 2012 to December 2017 was studied.Results: The mean operative time was 214.7±67.95 minutes (range, 100~360 minutes), including the time for intraoperative cholangiography. There were two children requiring blood transfusion. Time to first flatus was 40.35±28.55 hours in average. The mean time to drain removal was 2.89±1.02 days. Mean postoperative hospital stay was 9.31±3.43 days. 6 out of 51 cases having early complications, including 2 cases of pancreatitis and 4 cases of bile leakage. Most of cases (90.5%) were classified as good after 10 days to 3 months of follow-up.Conclusions: Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was feasible and safe in children. The short-term outcomes were good in most cases.