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Laparoscopic correction of biliary duct stenosis in choledochal cyst
Li, Long1; Liu, Shu-li2; Hou, Wen-Ying1; Cui, Long1; Liu, Xue-Lai1; Jun, Zhang1; Huang Liu-Ming2; Gang, Liu2; Kamal, Naved Alizai3
关键词choledochal cyst ductoplasty laparoscopy
WOS标题词Science & Technology
类目[WOS]Pediatrics ; Surgery
研究领域[WOS]Pediatrics ; Surgery

Background/Purposes: Laparoscopy has been widely accepted as a technique for the excision of choledochal cyst, but there has been little experience using it as a therapeutic modality for hepatic duct stenosis. The aim of this study is to present our experiences in laparoscopic excision of biliary stenosis and Roux-en-Y reconstruction for patients with choledochal cysts.

Methods: Eight patients, 3 boys and 5 girls (ranged from 6 months to 12 years; median age, 3.6 years), with hepatic duct stenosis underwent laparoscopic excision of the cyst and ductoplasty, with a Roux-en-Y hepaticoenterostomy between July 2001 and January 2005. Seven of the 8 patients had common hepatic duct stenosis with intrahepatic duct dilatation, and I had right hepatic duct stenosis with proximal dilatation. Four ports were inserted for instruments of 3- and 5-mm sizes. Each patient underwent a laparoscopic cholangiography. The gallbladder and dilated bile ducts were completely excised. The strictures of the hepatic ducts were treated by ductoplasty. The cut end of the duct was widened by incising along the anterior wall of the hepatic duct after excision of the narrow segment. By using intraoperative bile duct endoscopy, the optimal level of resection of the common hepatic duct was determined safely without endangering the orifices of the hepatic ducts or leaving any redundant duct, and the stone debris in the bile duct was identified and washed out. The Roux-en-Y jejunal loop was fashioned extracorporeally by exteriorizing the jejunum through the umbilical incision (1.0-1.5 cm) and passed up retrocolically followed by an end-to-side hepaticojejunostomy.

Results: The median duration of the operation was 4.3 hours (3.8-5.6 hours). Intraoperative bleeding was minimal, with no patients requiring blood transfusion. In 7 of the 8 cases, postoperative hospital stay ranged from 4 to 6 days; the other case had bile leak, which was cured by draining for 26 days without surgical intervention. All the patients had been followed up for 6 to 51 months. They stayed asymptomatic and well with no delayed complication.

Conclusions: Laparoscopically assisted hepatic ductoplasty is effective and safe for children with choledochal cyst. Bile duct endoscopy proved to be a valuable instrument in showing detailed variations of the biliary system and allowed a safe hepatic hilum exploration and accurate placed hepaticojejunal anastomosis. (c) 2008 Elsevier Inc. All rights reserved.

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作者单位1.Capital Inst Pediat, Dept Pediat Surg, Beijing 100020, Peoples R China
2.St James Univ Hosp, Dept Pediat Surg, Leeds LS9 7TF, W Yorkshire, England
3.Peking Univ, Affiliated Hosp, Dept Pediat Surg, Beijing 100034, Peoples R China
Recommended Citation
GB/T 7714
Li, Long,Liu, Shu-li,Hou, Wen-Ying,et al. Laparoscopic correction of biliary duct stenosis in choledochal cyst[J]. JOURNAL OF PEDIATRIC SURGERY,2008,43(4):644-646.
APA Li, Long.,Liu, Shu-li.,Hou, Wen-Ying.,Cui, Long.,Liu, Xue-Lai.,...&Kamal, Naved Alizai.(2008).Laparoscopic correction of biliary duct stenosis in choledochal cyst.JOURNAL OF PEDIATRIC SURGERY,43(4),644-646.
MLA Li, Long,et al."Laparoscopic correction of biliary duct stenosis in choledochal cyst".JOURNAL OF PEDIATRIC SURGERY 43.4(2008):644-646.
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