Laparoscopic surgery for choledochal cyst in children: A case review of 31 patients

Introduction: The results of the first substantial series of children suffering from choledochal cysts treated using laparoscopic surgery at the Shanghai Children's Medical Center, Shanghai, China are presented. Methods: Data from 31 sequentially treated children (average age 45.2 months, SD 36.5, range 2 to 168 months) with choledochal cyst treated by laparoscopic surgery were collected prospectively. The chief complaints included intermittent abdominal pain, vomiting, jaundice or pancreatitis. Two cases had no clinical symptoms; their diagnoses were based on prenatal ultrasound findings and confirmed postnatally. The laparoscopic technique included excision of the gall bladder and cyst, followed by a Roux-en-Y anastomosis constructed after exteriorization of the small bowel via an infraumbilical trocar incision. After repositioning of the bowel, an end-to-side hepaticojejunostomy was carried out laparoscopically. Results: The procedures were carried out successfully in 27 children and the average operating time was 5.2 hrs (4-7.5 firs). In 4 patients, the operations were converted to open surgery because of a giant cyst (diameter 10 cm; 1 case), serious inflammation and adhesions (2 cases), and hepatic duct malformation (1 case). Complications occurring postoperatively and cured by conservative treatment included hepaticojejunostomosis leakage (1 case), bowel ileus (1 case), pancreatitis (1 case), and pneumonia (1 case). Oral food intake was started within 3-5 days and patients were discharged within 7-14 days (average 8.6 days). All patients are well with bile-stained stools after an average follow-up of 16.3 months (range 2-43 months). The average cost was RMB 19167 ($ 2522, range RMB 12 600-34 538). Laparoscopic resection of congenital choledochal cyst and choledochojejunostomy in children is feasible and safe. The long-term results are good. There was a considerable learning curve during the development of the technique as experienced by the team.