J Korean Surg Soc.  2013 Nov;85(5):225-229.

Early experience of laparoscopic choledochal cyst excision in children

• Lee JH
• Kim SH
• Kim HY
• Choi YH
• Jung SE
• Park KW

Abstract

PURPOSE
Laparoscopic choledochal cyst excision with Roux-en-Y hepaticojejunostomy (LCE) in children is being attempted more frequently around the world, and although it has been performed in Korea, no publication has been published on it. However, cholangitis and/or pancreatitis are limitations that make open conversion more likely. The aims of this study, through a retrospective clinical analysis, were to prove the efficacy of LCE in children and to validate that preoperative management expands its indications.
METHODS
From May 2011 to November 2012, 13 pediatric LCEs were performed. Demo graphics, preoperative findings, management, operative and postoperative outcomes were reviewed.
RESULTS
The mean age at operation was 48.5 months and mean bodyweight 19.0 kg. Ultrasonography was conducted in all patients followed by either magnetic resonance cholangiopancreatography (8 cases) or computed tomography (5 cases). The mean diameter of the cysts was 30.2 mm. Eight patients with cholangitis and/or pancreatitis were given antibiotics preoperatively. Four had their condition resolved by administration of antibiotics, 3 underwent additional endoscopic retrograde biliary drainage or percutaneous transhepatic biliary drainage, and one, due to aggravating tenderness, underwent surgery after 4 days of administrating antibiotics without improvement of the inflammation. Two faced open conversions, one because of a very narrow bile duct, and the other because of remnant inflammation after inadequate preoperative management already mentioned above. Patients were discharged on the eighth postoperative day. There were no complications.
CONCLUSION
Pediatric LCE is a feasible option for choledochal cyst. Proper preoperative management such as antibiotics and drainage procedures enhances its efficacy by broadening its indications, even with concomitant cholangitis and/or pancreatitis.

Keyword

Choledochal cyst; Laparoscopy; Child

MeSH Terms

Anti-Bacterial Agents
Bile Ducts
Child*
Cholangiopancreatography, Magnetic Resonance
Cholangitis
Choledochal Cyst*
Drainage
Humans
Inflammation
Korea
Laparoscopy
Pancreatitis
Publications
Retrospective Studies
Ultrasonography
Anti-Bacterial Agents

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