Ann Surg Treat Res.  2019 Jul;97(1):21-26. 10.4174/astr.2019.97.1.21.

Minimally-invasive neonatal surgery: laparoscopic excision of choledochal cysts in neonates

• Ryu HS
• Lee JY
• Kim DY
• Kim SC
• Namgoong J

• KMID: 2450986
• DOI: http://doi.org/10.4174/astr.2019.97.1.21

Abstract

PURPOSE
Improvements in surgical techniques and a better understanding of the unique anesthetic requirements in neonates undergoing laparoscopy have suggested that laparoscopic surgery may be effective in newborns. This study therefore evaluated the safety and feasibility of laparoscopic excision of the cyst (LEC) in neonates.
METHODS
This retrospective study included 43 neonates who underwent excision of choledochal cysts between November, 2001, and January, 2018, including 21 who underwent open excision and 22 who underwent LEC. Their perioperative and surgical outcomes were reviewed. The patients were followed up for a median 37 months (range, 3-141 months).
RESULTS
Baseline characteristics did not differ significantly in the open and LEC groups. Mean intraoperative peak partial pressure of arterial CO2 (PaCO2) (45.5 mmHg vs. 48.0 mmHg) and total operation time (208.3 ± 71.0 minutes vs. 235.0 ± 47.2 minutes) were similar in both groups. Parents of the patients in the LEC group provided a more positive evaluation of scar scale and greater satisfaction with wound. No patient in either group experienced any critical complications. Three patients in the open excision group required readmission for cholangitis and 2 patients had ileus. No patient in the laparoscopic excision group experienced any postoperative complications during follow-up.
CONCLUSION
Despite difficulties performing laparoscopic surgery in neonates, LEC was safe and feasible when intraperitoneal peak pressure was maintained under 10 mmHg and PaCOâ‚‚ was closely monitored by a pediatric anesthesiologist. Compared with open excision, LEC provided improved cosmetic outcomes without severe complications. Prospective randomized studies with large numbers of patients are warranted.

Keyword

Choledochal cyst; Laparoscopy; Infant; Minimally invasive surgical procedures

MeSH Terms

Cholangitis
Choledochal Cyst*
Cicatrix
Follow-Up Studies
Humans
Ileus
Infant
Infant, Newborn*
Laparoscopy
Minimally Invasive Surgical Procedures
Parents
Partial Pressure
Postoperative Complications
Prospective Studies
Retrospective Studies
Wounds and Injuries

Figure

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  Fig. 1 Position of trocar.

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  Fig. 2 The distal portion of cyst was cut.

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  Fig. 3 Ruptured cyst with severe inflammation.

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  Fig. 4 The shape of an isosceles triangle to provide a better view for anastomosis.

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