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Kurauchi N, Mori Y, Nakamura Y, Tokumura H. Gallbladder and common bile duct. Asian J Endosc Surg 2024; 17:e13369. [PMID: 39278638 DOI: 10.1111/ases.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 09/18/2024]
Affiliation(s)
- Nobuaki Kurauchi
- Department of Surgery, Kutchan-Kosei General Hospital, Hokkaido, Japan
| | - Yasuhisa Mori
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Yoshiharu Nakamura
- Department of Surgery, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
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Ojha S, Bharadia L, Sharma R, Bansal RK, Chaturvedi A. Laparoscopic choledochal cyst excision and biliary reconstruction in patients with previous surgery/ intervention: Feasibility and outcome. J Minim Access Surg 2024; 20:121-126. [PMID: 38214346 PMCID: PMC11095812 DOI: 10.4103/jmas.jmas_269_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 09/26/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION 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 AND METHODS 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. RESULTS 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. CONCLUSIONS Laparoscopy in complicated CDC with previous intervention is technically tedious but is feasible. The procedure is safe and delivers a good outcome.
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Affiliation(s)
- Sunita Ojha
- Department of Pediatric Surgery, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
| | - Lalit Bharadia
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
| | - Ravi Sharma
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
| | - Rajiv Kumar Bansal
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
| | - Anupam Chaturvedi
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
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Di Fabrizio D, Alizai NK, Najmaldin AS. Early and Long-term Complications of Robotic Assisted Laparoscopy in Infants and Children. J Pediatr Surg 2023; 58:1832-1837. [PMID: 36997389 DOI: 10.1016/j.jpedsurg.2023.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/14/2023] [Accepted: 02/27/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Robotic-assisted laparoscopy still lacks wide acceptance in infants and children. We developed the service and report the largest single institution experience of complications over a period of 11 years. METHODS Between March 2006 and May 2017, consecutive infants and children who underwent robotic assisted laparoscopy under the care of two laparoscopic surgeons were studied. Data for patients, surgeons, year of surgery, operation, and timing, nature, grades of complications were assessed. RESULTS A total of 601 robotic procedures (45 different types) were carried out in 539 patients. Of these 31 (5.8%) were converted, none for operative complications. These and another 4 with complicated co-morbidity were excluded, leaving 504 patients for further analysis. There were 60 (11.9%) complications in 57 (11.3%) patients. Mean (SD) age was 7.7 years -/+5.1 with the youngest being 4 weeks. Concomitant or bilateral robotic and non-robotic procedures took place in 8.1% and 13.3% of patients respectively. Significant medical co-morbidity and abdominal scarring were present in 29% and 14.9% of patients respectively. Complications occurred in theatre 1.6%, hospital 5.6%, 28 days 1.2%, and late 3.6%. Mean follow up was 7.6 years -/+ 3.1 SD. Over-all postoperative complication rate was 10.3%: CD grade I 6.5% (33), II 0.6% (3), and IIIa/b 3.2% (16) which included 1.4% (7) re-do surgery. Most (11/16) grade III occurred late. There were no bleeding, grade IV or V complications, surgical mortality, or technology related complications. CONCLUSIONS Complications are low even during the learning phase and while developing the new technique. Most complications occurred early and were minor. Most high-grade complications presented late. LEVELS OF EVIDENCE 2B.
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Affiliation(s)
- Donatella Di Fabrizio
- Department of Paediatric Surgery, Leeds Teaching Hospitals, The General Infirmary, Leeds, UK
| | - Naved K Alizai
- Department of Paediatric Surgery, Leeds Teaching Hospitals, The General Infirmary, Leeds, UK
| | - Azad S Najmaldin
- Department of Paediatric Surgery, Leeds Teaching Hospitals, The General Infirmary, Leeds, UK.
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Mori Y, Okawara M, Shibao K, Kohi S, Tamura T, Sato N, Fujino Y, Fushimi K, Matsuda S, Hirata K. Changes in operative trends and short-term outcomes of surgery for congenital biliary dilatation in adults using real-world data: A multilevel analysis based on a nationwide administrative database in Japan. Ann Gastroenterol Surg 2023; 7:471-478. [PMID: 37152782 PMCID: PMC10154892 DOI: 10.1002/ags3.12630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/28/2022] [Indexed: 05/09/2023] Open
Abstract
Aim We aimed to evaluate the operative trends and compare the short-term outcomes between open and laparoscopic surgery for congenital biliary dilatation (CBD) in adults using real-world data from Japan. Methods Data from the Japanese Diagnosis Procedure Combination database on 941 patients undergoing surgery for CBD at 357 hospitals from April 1, 2016, to March 31, 2021, were analyzed. The patients were divided into two groups: open surgery (n = 764) and laparoscopic surgery (n = 177). We performed a retrospective analysis via a multilevel analysis of the short-term surgical outcomes and costs between open and laparoscopic surgery. Results The rate of laparoscopic surgery has been increasing annually and had almost doubled to 25% by 2021. There were no significant differences in the in-hospital mortality rate or postoperative morbidity between the two groups. The length of anesthesia was significantly longer in the laparoscopic than open surgery group (8.80 vs 6.16 hours, p < .001). The time to removal of the abdominal drain and length of hospital stay were significantly shorter in the laparoscopic than open surgery group (6.12 vs 8.35 days, p = .001 and 13.57 vs 15.79 days, p < .001, respectively). The coefficient for cost was 463 235 yen (95% confidence interval, 289 679-636 792) higher in laparoscopic than open surgery (p < .001). Conclusion The short-term results were comparable between laparoscopic and open surgery for CBD. Further investigation is needed to validate our findings and long-term outcomes.
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Affiliation(s)
- Yasuhisa Mori
- Department of Surgery 1, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Makoto Okawara
- Department of Environmental Epidemiology, Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Kazunori Shibao
- Department of Surgery 1, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Shiro Kohi
- Department of Surgery 1, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Toshihisa Tamura
- Department of Surgery 1, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Norihiro Sato
- Department of Surgery 1, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Kiyohide Fushimi
- Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate School of Medical and Dental SciencesTokyoJapan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Keiji Hirata
- Department of Surgery 1, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
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5
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Bian Z, Zhi Y, Zeng X, Wang X. Curative effect and technical key points of laparoscopic surgery for choledochal cysts in children. Front Surg 2023; 9:1051142. [PMID: 36684280 PMCID: PMC9852040 DOI: 10.3389/fsurg.2022.1051142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 01/07/2023] Open
Abstract
Objective The purpose of this study was to investigate the curative effect of and experience with laparoscopic surgery for congenital choledochal cysts in children. Methods This is a retrospective analysis of 33 children diagnosed with congenital choledochal cyst in the pediatric surgery department of the Affiliated Hospital of Southwest Medical University between January 2019 and December 2021. The cohort included 8 males and 25 females aged 0.25-13.7 years (median age, 3.2 years), including 21 cases of type I and 12 cases of type IV choledochal cyst (Todani classification). Laparoscopic choledochal cyst resection and hepaticojejunostomy with Roux-en-Y anastomosis were performed in all the patients. Results Laparoscopy without transit opening was successfully performed in the 33 cases. The duration of the procedure was 235-460 min (mean ± SD, 316 ± 61 min), and intraoperative blood loss volume was 15-40 ml (23 ± 7.6 ml). Postoperative hospital stay was 7-14 days (9 ± 1.8 days). Postoperative biliary fistula and pancreatitis occurred in two cases each, and all four patients were successfully treated with conservative treatment. No anastomotic stenosis, delayed bleeding, cholangitis, intestinal obstruction, or other complications occurred. All the children were followed up for 2-36 months (median period, 17.2 months). The clinical symptoms disappeared, and no obvious hepatic dysfunction was found on abdominal color ultrasound and liver function examination. Conclusion Laparoscopic surgery for congenital choledochal cyst in children is safe and effective, as it is a minimally invasive surgery that is associated with a low degree of trauma and bleeding, rapid postoperative recovery, and satisfactory aesthetic appearance.
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Affiliation(s)
- Zedong Bian
- Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China,Sichuan Clinical Research Center for Birth Defects, Luzhou, China,Correspondence: Zedong Bian
| | - Yong Zhi
- Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China,Sichuan Clinical Research Center for Birth Defects, Luzhou, China
| | - Xinhao Zeng
- Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China,Sichuan Clinical Research Center for Birth Defects, Luzhou, China
| | - Xiaoyong Wang
- Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China,Sichuan Clinical Research Center for Birth Defects, Luzhou, China
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Zhang MX, Chi SQ, Cao GQ, Tang JF, Tang ST. Comparison of efficacy and safety of robotic surgery and laparoscopic surgery for choledochal cyst in children: a systematic review and proportional meta-analysis. Surg Endosc 2023; 37:31-47. [PMID: 35913517 DOI: 10.1007/s00464-022-09442-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 07/04/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Most commonly, cyst excision and Roux-en-Y hepaticojejunostomy reconstruction are the optimal treatment for choledochal cysts (CC). Robotic surgery (RS) is being conducted with increasing frequency to treat CC. It is unclear whether RS can overcome the limitations of laparoscopic surgery (LS) and improve the prognosis of patients. In terms of efficacy, evidence concerning which minimally invasive surgery is preferred is, however, sparse. Our objective is to further compare the efficacy of RS and LS in children with CC and draw a useful clinical conclusion. METHODS Studies meeting inclusion criteria were identified from a series of databases, consisting of PubMed, Embase, Scopus, Web of Science, the Cochrane Library and their reference list of articles up to May 2022. Eligible articles comprised at least five objects that were younger than 18 years of age and the language was limited to English. Two authors independently evaluated selected studies and extracted data for analysis. RESULTS Forty studies were selected for analysis, with thirty-six reporting data on LS and eight containing data on RS. The pooled conversion rate and pooled postoperative complication rate of RS were lower than those of LS, but none of them was statistically significant. Moreover, comparisons of the following detailed postoperative complication rates were not statistically significant, such as intestinal obstruction or ileus, anastomotic bleeding, anastomotic or bile leakage, and anastomotic stenosis. However, the intraoperative blood loss and the postoperative hospital stay in RS group were significantly lower than those in LS group. CONCLUSIONS RS is a safe and feasible option for children with CC. Further studies with more cases, long-term efficacy and health economics analysis are needed to confirm whether RS is more advantageous.
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Affiliation(s)
- Meng-Xin Zhang
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Shui-Qing Chi
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Guo-Qing Cao
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Jing-Feng Tang
- Department of Hepatobiliary Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Shao-Tao Tang
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China.
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Schukfeh N, Abo-Namous R, Madadi-Sanjani O, Uecker M, Petersen C, Ure BM, Kuebler JF. The Role of Laparoscopic Treatment of Choledochal Malformation in Europe: A Single-Center Experience and Review of the Literature. Eur J Pediatr Surg 2022; 32:521-528. [PMID: 35764302 DOI: 10.1055/s-0042-1749435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Numerous studies from Asian countries, including large collectives, have reported excellent results after laparoscopic resection of choledochal malformation (CM). However, the role of laparoscopic CM resection is still controversial outside Asia. We aimed to analyze the outcome of laparoscopic CM resection in our institution and to compare our outcome with the data reported in the literature. METHODS All patients who underwent laparoscopic CM resection in our pediatric surgical department from 2002 to 2019 were retrospectively analyzed for surgical details and postoperative complications, which were graded according to the Clavien-Dindo classification. A systematic literature search identified all reports on over 10 cases of laparoscopic pediatric CM resection and surgical details, follow-up, and complication rates were extracted. RESULTS Fifty-seven patients (72% female) with a mean age of 3.6 + 4.1 years underwent laparoscopic CM resection in our department. Conversion rate was 30%. Total complication rate was 28%. The rate of major complications (Clavien-Dindo grade III or more) was 16% and included stricture of the biliodigestive or enteric anastomosis (n = 4), adhesive ileus (n = 3), portal vein thrombosis (n = 1), and recurrent cholangitis with consecutive liver transplantation (n = 1). With increasing experience, complication rates decreased. The majority of publications on laparoscopic CM resections originated from Asia (n = 36) and reported on low complication rates. In contrast, publications originating from non-Asian countries (n = 5) reported on higher complications following laparoscopic CM resection. CONCLUSION Our data indicate that laparoscopic CM resection can be safely performed. The learning curve in combination with the low incidence calls for a centralization of patients who undergo laparoscopic CM resection. There seems to be a discrepancy on complications rates reported from Asian and non-Asian countries following laparoscopic CM resection.
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Affiliation(s)
- Nagoud Schukfeh
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Reem Abo-Namous
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | | | - Marie Uecker
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Claus Petersen
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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8
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Tainaka T, Shirota C, Hinoki A, Sumida W, Yokota K, Makita S, Amano H, Tanaka Y, Uchida H. Laparoscopic definitive surgery for congenital biliary dilatation with aggressive hilar bile ductoplasty and complete resection of the intrapancreatic bile duct in pediatric patients is safe and effective, comparable to open surgery. Surg Endosc 2022; 36:7352-7359. [PMID: 35226163 DOI: 10.1007/s00464-022-09132-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND After surgery for congenital biliary dilatation (CBD), hilar and hepatic bile duct stenosis and intrapancreatic bile duct remnants can cause many postoperative complications. We investigated the efficacy of laparoscopic surgery with aggressive bile ductoplasty and complete excision of the intrapancreatic bile duct in CBD patients compared to open surgery. METHODS Pediatric patients who underwent surgery for CBD at our institution between 2006 and 2020 were divided into two groups: laparoscopic surgery (Lap group) and open surgery (Op group). Surgical outcomes were compared between the two groups. RESULTS We enrolled 160 patients (85 in the Lap group and 75 in the Op group). Hilar bile ductoplasty was performed in 52 (61%) patients from the Lap group and 40 (53%) patients from the Op group. The operative time was significantly longer, the amount of blood loss was significantly lower, and the length of hospital stay was significantly shorter in the Lap group than in the Op group. Postoperative early and late complications occurred at a similarly low rate in both groups. When the surgical outcomes were compared between the group who underwent laparoscopic bile ductoplasty and the group that did not, postoperative early and late complications occurred similarly in both groups. CONCLUSIONS Laparoscopic surgery for CBD with aggressive hilar bile ductoplasty and complete excision of the intrapancreatic bile duct is safe and effective, comparable to open surgery. However, it is necessary to verify whether long-term occurrence of hepatolithiasis similar to open definitive surgery can be obtained in the future.
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Affiliation(s)
- Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
- Department of Pediatric Surgery, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
- Department of Pediatric Surgery, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
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Kiblawi R, Zoeller C, Zanini A, Kuebler JF, Dingemann C, Ure B, Schukfeh N. Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies. Eur J Pediatr Surg 2022; 32:9-25. [PMID: 34933374 DOI: 10.1055/s-0041-1739418] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There is still a call for well-founded evidence. We reviewed the literature on studies published in the last three decades and dealing with advantages and disadvantages of laparoscopy compared to open surgery. MATERIALS AND METHODS Studies comparing laparoscopic versus open abdominal procedures in children were searched in PubMed/MEDLINE. Reports on upper and lower gastrointestinal as hepatobiliary surgery and on surgery of pancreas and spleen were included. Advantages and disadvantages of laparoscopic surgery were analyzed for different types of procedures. Complications were categorized using the Clavien-Dindo classification. RESULTS A total of 239 studies dealing with 19 types of procedures and outcomes in 929,157 patients were analyzed. We identified 26 randomized controlled trials (10.8%) and 213 comparative studies (89.2%). The most frequently reported advantage of laparoscopy was shorter hospital stay in 60.4% of studies. Longer operative time was the most frequently reported disadvantage of laparoscopy in 52.7% of studies. Clavien-Dindo grade I to III complications (mild-moderate) were less frequently identified in laparoscopic compared to open procedures (80.3% of studies). Grade-IV complications (severe) were less frequently reported after laparoscopic versus open appendectomy for perforated appendicitis and more frequently after laparoscopic Kasai's portoenterostomy. We identified a decreased frequency of reporting on advantages after laparoscopy and increased reporting on disadvantages for all surgery types over the decades. CONCLUSION Laparoscopic compared with open pediatric surgery seems to be beneficial in most types of procedures. The number of randomized controlled trials (RCTs) remains limited. However, the number of reports on disadvantages increased during the past decades.
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Affiliation(s)
- Rim Kiblawi
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Zoeller
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.,Department of Pediatric Surgery, University Hospital Munster, Munster, Nordrhein-Westfalen, Germany
| | - Andrea Zanini
- Department of Pediatric Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Carmen Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Benno Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Nagoud Schukfeh
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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Pandey V, Srivastava V, Panigrahi P, Kumar R, Sharma SP. Modified Laparoscopic Excision of Choledochal Cyst: Technique and Early Results. J Indian Assoc Pediatr Surg 2021; 26:311-316. [PMID: 34728916 PMCID: PMC8515537 DOI: 10.4103/jiaps.jiaps_150_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Vaibhav Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vivek Srivastava
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pranay Panigrahi
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rakesh Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shiv Prasad Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Liem NT, Agrawal V, Aison DS. Laparoscopic management of choledochal cyst in children: Lessons learnt from low-middle income countries. J Minim Access Surg 2021; 17:279-286. [PMID: 32964871 PMCID: PMC8270031 DOI: 10.4103/jmas.jmas_114_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Choledochal cyst (CC) is a disease with a strong Asian preponderance. As laparoscopic surgery has become mainstay in its treatment, the experience in these countries has been phenomenal. However, there are many contentious issues related with the laparoscopic management of CC. In this review article, we will try to answer the contentious questions related to the laparoscopic management of CC. The issues related to aetiology, classification, surgical technique, type of biliary anastomosis, intrahepatic stones and malignancy are discussed. We also discuss the current and future considerations of laparoscopic management with reference to it becoming a gold standard. This article describes the standard surgical approach and will discuss its technical nuances. This article will also discuss the outcome of treatment in different settings of low- and middle-income countries based on lessons learnt by the authors from their experience and research.
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Affiliation(s)
- Nguyen Thanh Liem
- Department of Pediatric Surgery, National Children Hospital, Hanoi; Department of Pediatric Surgery, Vinmec Research Institute of Stemcell and Gene Technology, Hà Nôi, Vietnam
| | - Vikesh Agrawal
- Department of Surgery, Division of Pediatric Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Dexter S Aison
- Department of Pediatric Surgery, Philippine Children's Medical Center, Quezon City, Philippines
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Comparison of efficacy and safety of laparoscopic excision and open operation in children with choledochal cysts: A systematic review and update meta-analysis. PLoS One 2020; 15:e0239857. [PMID: 32986787 PMCID: PMC7521726 DOI: 10.1371/journal.pone.0239857] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023] Open
Abstract
Objective The outcomes of children with Choledochal cyst who undergo laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy versus open cyst excision and Roux-en-Y hepaticojejunostomy have not been adequately compared. We conducted a systematic review and meta-analysis to gain further insight into the efficacy and safety of laparoscopic excision in children with choledochal cysts. Methods A systematic search of PubMed, Embase, Cochrane Central Register, and ClinicalTrials.gov databases from January 1973 to January 31, 2020 was performed utilizing the PRISMA guidelines. Short-term, long-term and total postoperative complications were the primary endpoint measurements, whereas intraoperative outcomes and other postoperative outcomes were the secondary endpoints. Results The final analysis included 14 retrospective cohorts comprising 1767 patients. There were no significant differences in the patients’ short-term postoperative complications (RR = -1.08; 95% CI = -1.72 to -0.67) between the 2 approaches. However, improvements in long-term (RR = 0.09; 95% CI = 0.01 to 0.18) and total postoperative complications (RR = -0.29; 95% CI = -0.40 to -0.21), estimated intraoperative blood loss and transfusion, time of initial feeding, and length of hospital stay were observed in patients who underwent laparoscopic excision when compared to those who underwent open surgery. Conclusions Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy provides similar or even improved intraoperative, postoperative outcomes when compared to open excision for children with Choledochal cyst.
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Yeung F, Fung ACH, Chung PHY, Wong KKY. Short-term and long-term outcomes after Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy following laparoscopic excision of choledochal cyst in children. Surg Endosc 2019; 34:2172-2177. [DOI: 10.1007/s00464-019-07004-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/19/2019] [Indexed: 02/08/2023]
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Qu X, Cui L, Xu J. Laparoscopic Surgery in the treatment of children with Choledochal Cyst. Pak J Med Sci 2019; 35:807-811. [PMID: 31258599 PMCID: PMC6572986 DOI: 10.12669/pjms.35.3.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/09/2019] [Accepted: 03/19/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the clinical effectiveness of laparoscopic surgery in the treatment of children with choledochal cyst. METHODS Seventy-six children with congenital choledochal cyst who were admitted to our hospital between February 2016 and April 2017 were selected as research subjects. They were evenly divided into an observation group and a control group using random number table, 38 each group. Patients in the observation group underwent laparoscopic surgery, while patients in the control group underwent the traditional laparotomy. Surgery related indicators and prognosis were compared between the two groups. RESULTS The incision size and intraoperative bleeding volume of the observation group were significantly smaller than those of the control group (P<0.05). The time of passage of flatus and time to take food of the observation group were easier than those of the control group, and the duration of hospitalization and parenteral nutrition of the former was significantly shorter than those of the latter, and the difference had statistical significance (P<0.05). The incidence of postoperative complications in the observation group was 2.6%, significantly lower than that in the control group (10.5%) (P<0.05). There was no recurrence in the observation group during the follow-up period, but there were 5 cases of recurrence (13.1%) in the control group; the difference was statistically significant (P<0.05). CONCLUSION Compared with the traditional laparotomy, laparoscopic surgery conforms more to the concept of modern medical minimally invasive treatment and has a significant clinical effect in the treatment of congenital choledochal cyst in children. It can effectively promote the disappearance of clinical symptoms and signs, reduce the incidence of postoperative complications and disease recurrence, and improve the surgical efficacy, suggesting high clinical significance and application values.
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Affiliation(s)
- Xiushui Qu
- Xiushui Qu, Department of Pediatric Surgery, Binzhou People’s Hospital, Shandong, 256610, China
| | - Lihua Cui
- Lihua Cui, Department of Hand and Foot Surgery, Binzhou People’s Hospital, Shandong, 256610, China
| | - Junchao Xu
- Junchao Xu, Department of Pediatric Surgery, Binzhou People’s Hospital, Shandong, 256610, China
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Talini C, DE-Carvalho BCN, Antunes LA, Schulz C, Sabbaga CC, Avilla SGA, Garbers JC, DE-Aguiar LRF, Telles LG, DE-Almeida GC, Amado FAB, E-Silva EDEM. Choledochal cyst in the pediatric population: experience of 13 laparoscopic procedures in two years at a single institution. ACTA ACUST UNITED AC 2018; 45:e1854. [PMID: 29995153 DOI: 10.1590/0100-6991e-20181854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/22/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE to describe the first 13 cases of laparoscopic correction of common bile duct cyst in the Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil. METHODS we performed a retrospective analysis of medical records of cases of choledochal cyst operated by laparoscopy between March 2014 and September 2016. RESULTS of the 13 patients, eight were female and the mean age at surgery was 7.8 years. The most common symptom was abdominal pain. The hepaticoduodenal anastomosis was the most used reconstruction technique, in 84.6% of the cases. There was no conversion to laparotomy or intraoperative complications. Only one patient presented anastomotic fistula and was reoperated by laparotomy. All patients were followed up in an outpatient clinic, were asymptomatic and had no episode of cholangitis after surgery, with a mean follow-up of 16 months. CONCLUSION laparoscopy is a safe method to correct choledochal cysts, even in younger children, with low rates of complications and low rates of conversion to open surgery when performed by well trained surgeons.
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Affiliation(s)
- Carolina Talini
- - Pequeno Príncipe Hospital, Department of Pediatric Surgery, Curitiba, PR, Brazil
| | | | | | - Claudio Schulz
- - Pequeno Príncipe Hospital, Department of Pediatric Surgery, Curitiba, PR, Brazil
| | | | | | - João Carlos Garbers
- - Pequeno Príncipe Hospital, Department of Pediatric Surgery, Curitiba, PR, Brazil
| | | | - Leila Grisa Telles
- - Pequeno Príncipe Hospital, Department of Pediatric Surgery, Curitiba, PR, Brazil
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Abstract
Comparative studies and large-scale case series that confirm the advantages of laparoscopy in children with hepatobiliary diseases are scarce, and the use of laparoscopy remains a matter of debate. This article reviews the current literature on the role of laparoscopic and robotic surgery in pediatric patients with choledochal cyst, biliary atresia, gallbladder diseases, and hepatobiliary malignancies. Studies were identified through a search of the MEDLINE database. Laparoscopy may be beneficial for resection of choledochal cyst and cholecystectomy. However, more data are required before recommendations on the use of minimally invasive techniques for other hepatobiliary conditions can be published.
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Affiliation(s)
- Omid Madadi-Sanjani
- Centre of Pediatric Surgery Hannover, Hannover Medical School, Carl-Neuberg-Street 1, Hannover 30625, Germany.
| | - Claus Petersen
- Centre of Pediatric Surgery Hannover, Hannover Medical School, Carl-Neuberg-Street 1, Hannover 30625, Germany
| | - Benno Ure
- Centre of Pediatric Surgery Hannover, Hannover Medical School, Carl-Neuberg-Street 1, Hannover 30625, Germany
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Miyano G, Koyama M, Miyake H, Kaneshiro M, Morita K, Nakajima H, Yamoto M, Nouso H, Fukumoto K, Urushihara N. Comparison of laparoscopic hepaticojejunostomy and open hepaticojejunostomy. Can stenosis of the hilar hepatic duct affect postoperative outcome? Asian J Endosc Surg 2017; 10:295-300. [PMID: 28134491 DOI: 10.1111/ases.12358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/04/2016] [Accepted: 12/20/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to compare laparoscopic hepaticojejunostomy (LHJ) and open hepaticojejunostomy (OHJ) for choledochal cyst associated with hilar hepatic duct stenosis (HHDS). METHODS Data collection was prospective for LHJ cases from 2009 and retrospective for OHJ cases from 2003 to 2008. Data were compared with respect to HHDS. HHDS was incised longitudinally as required during hilar hepatic ductoplasty. RESULTS Fifty-eight subjects were studied (LHJ: n = 27, 4 boys, 23 girls; OHJ: n = 31; 6 boys, 25 girls). HHDS was present in 10 LHJ cases and 10 OHJ cases. Todani classification of choledochal cyst in LHJ patients was type 1A (n = 16) and type 4A (n = 11), and in OHJ patients, it was type 1A (n = 19) and type 4A (n = 12). There were significant differences between LHJ and OHJ with regard to mean operative time (386 vs 341 min), mean blood loss (5.9 vs 18.4 mL), recommencement of enteral feeding (3.9 vs 6.4 days), and hospital stay (11.7 vs 15.5 days) (all P < 0.05). Hepatic ductoplasty was performed in 23 LHJ patients and in 21 OHJ patients. There were no intraoperative complications and no conversions to OHJ. There were no significant differences between LHJ and OHJ, regardless of the presence of HHDS, for postoperative complications, which included minor bile leakage, anastomotic stricture, and intestinal obstruction. CONCLUSION LHJ is as effective as OHJ for the treatment of choledochal cysts irrespective of the presence of HHDS and the need for hepatic ductoplasty.
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Affiliation(s)
- Go Miyano
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Mariko Koyama
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masakatsu Kaneshiro
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Keiichi Morita
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hideaki Nakajima
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiroshi Nouso
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
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Laparoscopic excision versus open excision for the treatment of choledochal cysts: a systematic review and meta-analysis. Int Surg 2016; 100:115-22. [PMID: 25594650 PMCID: PMC4301275 DOI: 10.9738/intsurg-d-14-00165.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In 1723, Vater first described choledochal cyst and in 1977, Todani et al classified this disease. For many years, open excision (OP) as the standard procedure made a great impact in the treatment of choledochal cyst. Since 1995, when Farello et al first reported laparoscopic choledochal cyst excision, laparoscopic excision (LA) has been used worldwide. However, its safety remains a major concern. The aim of this meta-analysis was to compare OP with LA in treating choledochal cyst and then to determine whether LA is safe and valid. The design of this study involved systematic review and meta-analysis. Data sources were Medline, Ovid, Elsevier, Google Scholar, Embase, and Cochrane library. The study selection entailed comparative cohort studies. For data extraction, 2 investigators independently assessed selected studies and extracted the following information: study characteristics, quality, outcomes data, etc. For the results, 7 comparative cohort studies about the effectiveness of LA compared with OP were performed meta-analysis. The results showed that although the LA group had a longer operative time (MD = 56.57; 95% CI = 32.20–80.93; P < 0.00001), LA had a shorter duration of hospital stay (MD = −1.93; 95% CI = −2.51 to −1.36; P < 0.00001), and recovery of bowel function (MD = −0.94; 95% CI = −1.33 to −0.55; P < 0.00001). Meta-analysis found no significant difference between most of the 2 groups: bile leak (RR = 0.60; 95% CI = 0.29–1.24; P = 0.17), abdominal bleeding (RR = 0.33; 95% CI = 0.01–8.98; P = 0.51), pancreatitis (RR = 0.26, 95% CI = 0.06–1.03; P = 0.06), total postoperative complications (RR = 1.04; 95% CI = 0.66–1.62; P = 0.88). The LA group had significant lower rates in intraoperative blood transfusion (RR = 0.20; 95% CI = 0.11–0.38; P < 0.00001), and adhesive intestinal obstruction (RR = 0.17, 95% CI = 0.04–0.77; P = 0.02). In conclusion, compared with open excision, laparoscopic excision is a safe, valid, and feasible alternative to open excision.
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Wen Z, Liang H, Liang J, Liang Q, Xia H. Evaluation of the learning curve of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: CUSUM analysis of a single surgeon's experience. Surg Endosc 2016; 31:778-787. [PMID: 27338584 PMCID: PMC5266761 DOI: 10.1007/s00464-016-5032-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/11/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy is gaining popularity as a treatment for choledochal cyst (CDC) in children. However, the learning curve for this challenging laparoscopic procedure has not been addressed. The aim of this study is to determine the characteristics of the learning curve of this procedure. This may guide the training in institutions currently not using this technique. METHODS A prospectively collected database comprising all medical records of the first 104 consecutive patients undergoing laparoscopic CDC excision and Roux-en-Y hepaticojejunostomy performed by one surgeon was studied. Multifactorial linear/logistic regression analysis was performed to identify patient-, surgeon-, and procedure-related factors associated with operating times, rates of adverse event, and length of postoperative stay. RESULTS Cumulative sum analysis demonstrated a learning curve for laparoscopic choledochal cyst excision of 37 cases. Comparing the early with the late experiences (37 vs. 67 cases), the surgeon-specific outcomes significantly improved in terms of operating times (352 vs. 240 min; P < 0.001), postoperative complication rate (13.5 vs. 1.5 %; P = 0.02), and the length of hospital stay (9.4 vs. 7.8 days; P = 0.01). After multivariate analyses, independent predictors of operating times included the completion of the learning curve (CLC) (OR 0.68, 95 % CI 0.63-0.73) and adhesion score (ORmiddle 1.25, 95 % CI 1.08-1.45; ORhigh 1.40, 95 % CI 1.20-1.62; compared with the low score); significant predictors of perioperative adverse outcomes were CLC (OR 0.07, 95 % CI 0.02-0.34) and comorbidities prior to the surgery (OR 30.65, 95 % CI 1.71-549.63). The independent predictors of length of postoperative stay included CLC, preoperative comorbidities, and perioperative adverse events. CONCLUSIONS CLC for laparoscopic choledochal cyst excision is 37 cases. After CLC, not only the operative time is reduced, the complications, adverse results, and the length of hospital stay all decreased significantly. The learning curve can be used as the basis for performance guiding the training.
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Affiliation(s)
- Zhe Wen
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiankun Liang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Qifeng Liang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Huimin Xia
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China.
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Laparoscopic versus open surgery in children with choledochal cysts: a meta-analysis. Pediatr Surg Int 2015; 31:529-34. [PMID: 25895070 DOI: 10.1007/s00383-015-3705-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the safety and efficacy between laparoscopic and open cyst excision with hepaticojejunostomy for children with choledochal cysts using meta-analysis. METHODS Studies comparing the laparoscopic and the open choledochal cyst excision that met the inclusion criteria for data extraction were identified from electronic databases (PubMed, Embase, Science Citation Index, and the Cochrane Library) up to November 2014. The proceedings of relevant congress were also searched. The outcomes were operative time, intraoperative blood loss, time to food intake, postoperative morbidity and mortality, length of hospital stay. Outcomes were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using RevMan 5.2. RESULTS Seven retrospective studies were finally included, involving a total of 1016 patients, of whom, 408 cases underwent laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy (LH) and 608 cases underwent open cyst excision and Roux-en-Y hepaticojejunostomy (OH). In LH group compared with OH group, the operative time was longer (MD = 59.11, 95% CI 27.61-90.61, P = 0.0002), while the length of postoperative hospital stay was less (MD = -2.01, 95% CI -2.49 to -1.54, P < 0.00001), the intraoperative blood loss was lower (MD = -37.14, 95% CI -66.69 to -7.60, P = 0.01) and time to food intake was less (MD = -1.14, 95% CI -1.61 to -0.67, P = 0.01). The rate of postoperative morbidity was more in the OH group, but there is no statistically significant difference between the two groups in postoperative morbidity (OR = 0.52, 95% CI 0.13-2.06, P = 0.35). CONCLUSION Laparoscopic surgery is a feasible, safe treatment of choledochal cyst with less postoperative morbidity, a shorter length of stay and a lower blood loss when compared with open approach. With the improvement of laparoscopic techniques and deftness of surgeons practice, laparoscopic surgery may become the first choice procedure for choledochal cyst.
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Yeung F, Chung PHY, Wong KKY, Tam PKH. Biliary-enteric reconstruction with hepaticoduodenostomy following laparoscopic excision of choledochal cyst is associated with better postoperative outcomes: a single-centre experience. Pediatr Surg Int 2015; 31:149-53. [PMID: 25433691 DOI: 10.1007/s00383-014-3648-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND With the advent of laparoscopic surgery, more choledochal cysts are excised laparoscopically. In this study, we compared the outcomes from laparoscopic hepaticojejunostomy (HJ) and hepaticoduodenostomy (HD) for biliary-enteric reconstruction. METHODS A retrospective analysis of patients who had undergone laparoscopic choledochal cyst excision between February 2005 and January 2014 in a tertiary referral centre was performed. Demographics data, operative techniques and surgical outcomes were analysed according to the way of biliary-enteric reconstruction. RESULTS A total of 31 patients were identified, 20 of whom underwent HJ and 11 underwent HD. There were no significant differences in terms of demographics. Median operative time was significantly shorter in HD group (211.0 ± 96.4 vs. 386.0 ± 90.4 min, p = 0.001). Although postoperative enteral feeding was initiated later in HD group (5.0 ± 0.8 vs. 4.0 ± 3.6 days, p = 0.036), postoperative stay in intensive care unit (ICU) (0.7 ± 1.0 vs. 2.4 ± 1.7 days, p = 0.007) and overall hospital stay (9.1 ± 1.0 vs. 14.4 ± 12.2 days, p = 0.157) favoured HD group. There was no perioperative mortality. Median follow-up duration was 24.0 (±11.0) months in HD group and 67.5 (±23.7) months in HJ group. One patient in HJ group had postoperative cholangitis related to anastomotic stricture whereas no cholangitis noted in HD group. In total, five patients in HJ group required second operation for complications and residual diseases whereas none in HD group required reoperation. CONCLUSIONS Laparoscopic excision of choledochal cyst with hepaticoduodenostomy reconstruction is safe and feasible with shorter operative time, ICU stay and overall hospital stay. It is not inferior to HJ in terms of short-term postoperative outcomes.
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Affiliation(s)
- Fanny Yeung
- Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Son TN, Liem NT, Hoan VX. Transumbilical Laparoendoscopic Single-Site Surgery with Conventional Instruments for Choledochal Cyst in Children: Early Results of 86 Cases. J Laparoendosc Adv Surg Tech A 2014; 24:907-10. [DOI: 10.1089/lap.2014.0268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tran Ngoc Son
- Surgical Department, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Nguyen Thanh Liem
- Surgical Department, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Vu Xuan Hoan
- Surgical Department, National Hospital of Pediatrics, Hanoi, Vietnam
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Immunoglobulin G4-associated cholangitis mimicking cholangiocarcinoma treated by laparoscopic choledochectomy with intracorporeal Roux-en-Y hepaticojejunostomy. World J Surg Oncol 2014; 12:363. [PMID: 25432590 PMCID: PMC4258796 DOI: 10.1186/1477-7819-12-363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/18/2014] [Indexed: 12/24/2022] Open
Abstract
Immunoglobulin G4 (IgG4)-associated disease is a recently recognized disease entity that is characterized by elevated serum IgG4 concentrations, abundant IgG4 lymphoplasmacytic infiltration, and dramatic steroid responses. IgG4-associated cholangitis is one manifestation of IgG4-associated disease. However, it is clinically challenging to make a preoperative differentiation between this rare disease and cholangiocarcinoma, especially for those with serum concentrations of IgG4 in the normal range. This article reports on a 57-year-old man with jaundice and upper abdominal discomfort. Imaging examination showed biliary stricture that closely resembled cholangiocarcinoma, and the patient’s serum IgG4 concentration was normal. The patient underwent a laparoscopic choledochectomy with Roux-en-Y hepaticojejunostomy using an intracorporeal hand-sewn technique. He recovered quickly without any complications. We also present our experience in laparoscopic intracorporeal hand-sewn hepaticojejunostomy.
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Ng JL, Salim MT, Low Y. Mid-term Outcomes of Laparoscopic Versus Open Choledochal Cyst Excision in a Tertiary Paediatric Hospital. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2014. [DOI: 10.47102/annals-acadmedsg.v43n4p220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Paediatric laparoscopic choledochal cyst excision has increasingly gained acceptance as an alternative to open excision. Laparoscopic excision is feasible and safe in the short term, but long-term outcomes are not as well established. KK Women’s and Children’s Hospital started performing laparoscopic choledochal cyst excision in children since 2007. In this paper, we report our experience with the laparoscopic approach, and the early and mid-term outcomes in comparison with the conventional open approach. Materials and Methods: Thirty-five consecutive cases by a single surgeon between May 2006 and April 2012 were retrospectively reviewed. Patient characteristics and surgical outcomes were analysed. Results: There were 13 laparoscopic and 22 open cases. Baseline patient characteristics were similar. Operative time was longer in the laparoscopic group. Three cases in the laparoscopic group were converted to open in our early experience. There were no differences in time to feeds or length of hospitalisation. One laparoscopic case developed minor bile leak that resolved on conservative management. There were no complications in the laparoscopic group on median follow-up of 35 months. In the open group, there was 1 case of pancreatitis, cholangitis, and hypertrophic scarring respectively. There were 3 cases of suspected adhesive colic that resolved without surgery. Conclusion: Laparoscopic choledochal cyst excision enjoys excellent early and mid-term outcomes compared to open excision, even in centres with smaller patient volume. It should be the approach of choice where technical expertise is available.
Key words: Hepaticojejunostomy, Minimally invasive, Postoperative outcomes
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Affiliation(s)
- Jia Lin Ng
- KK Women’s and Children’s Hospital, Singapore
| | | | - Yee Low
- KK Women’s and Children’s Hospital, Singapore
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25
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Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children. Pediatr Surg Int 2014; 30:291-4. [PMID: 24458067 DOI: 10.1007/s00383-013-3459-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE Choledochal cysts have traditionally been treated as an open procedure. However, recent publications from some large volume centres show that minimally invasive surgery has become their standard approach. Robotic surgical systems facilitate a surgeon's ability to undertake complex procedures. We present our experience of using robot assistance to treat choledochal cysts. METHODS Children admitted with a choledochal cyst from March 2009 to Nov 2012 were included. There were 27 patients (20 females). Mean age 5.4 years (range 0.3-15.9). Mean weight 21.9 kg (range 5.9-78.8); 10 weighed <10 kg. The choledochal cysts were types 1c(12), 1f(10) and 4(5). The da vinci Surgical System was used for the robot-assisted resection of the choledochal cyst and hepaticojejunostomy. Roux loop was fashioned extra-corporeally. Mean follow-up is 2.7 years (range 0.9-4.7). RESULTS 22 cases were completed successfully with robotic assistance. Five open conversions were for anatomical concerns or technical reasons. One child had three complications (omental hernia, anastomotic stricture and subsequent bile leak). Patients were on full feeds by a median of 5 days (range 3-6) and discharged after 6 days (range 4-7). CONCLUSION Robotic-assisted resection of choledochal cysts in children is safe. They made a rapid recovery with a good cosmetic outcome.
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Comparison of therapeutic effects of laparoscopic and open operation for congenital choledochal cysts in adults. Gastroenterol Res Pract 2014; 2014:670260. [PMID: 24719612 PMCID: PMC3955616 DOI: 10.1155/2014/670260] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 12/25/2013] [Accepted: 12/26/2013] [Indexed: 01/08/2023] Open
Abstract
Background. Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for treating congenital choledochal cysts (CCCs) have proved to be efficacious in children. Its safety and efficacy in adult patients remain unknown. The purpose of this study was to determine whether the laparoscopic procedure was feasible and safe in adult patients. Methods. We reviewed 35 patients who underwent laparoscopic operation (laparoscopic group) and 39 patients who underwent an open procedure (open group). The operative time, intraoperative blood loss, time until bowel motion recovery, duration of drainage, postoperative stay, time until resumption of diet, postoperative complications, and perioperative laboratory values were recorded and analyzed in both groups. Results. The operative time was longer in the laparoscopic group and decreased significantly with accumulating surgical experience (P < 0.01). The mean intraoperative blood loss was significantly lower in the laparoscopic group (P < 0.01). The time until bowel peristalsis recovery, time until resumption of diet, abdominal drainage, and postoperative stay were significantly shorter in the laparoscopic group (P < 0.01). The postoperative complication rate was not higher in the laparoscopic group than in the open group (P > 0.05). Conclusions. Laparoscopic cyst excision and hepaticojejunostomy are a feasible, effective, and safe method for treating CCCs in adult patients.
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Laparoscopic surgery for choledochal cysts. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 20:487-91. [PMID: 23572286 DOI: 10.1007/s00534-013-0608-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Laparoscopic cystectomy has become a common procedure for choledochal cysts. The cyst should be removed completely just above the confluence of the common biliopancreatic channel at the distal end and approximately 5 mm from the confluence of the right and left hepatic ducts at the proximal end to avoid complications of the cystic remnant. The operation is feasible and safe. The rate of conversion to open surgery is low. The rate of complication under skill laparoscopic surgeons is also low, even lower than in open surgery. There was no difference between hepaticoduodenostomy and hepaticojejunostomy concerning the rate of cholangitis. Gastritis due to bilious reflux occurred with a low rate in hepaticoduodenostomy. Both techniques could be used for choledochal cysts; however, hepaticoduodenostomy should be applied for choledochal cysts without intrahepatic dilatation of biliary tract.
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Lee JH, Kim SH, Kim HY, Choi YH, Jung SE, Park KW. Early experience of laparoscopic choledochal cyst excision in children. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:225-9. [PMID: 24266013 PMCID: PMC3834021 DOI: 10.4174/jkss.2013.85.5.225] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 02/07/2023]
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.
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Affiliation(s)
- Joon-Hyop Lee
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Laparoscopy enables surgeons to approach the surgical conditions from a new perspective. Laparoscopic surgery has revolutionized the treatment of choledochal cysts (CDC). Yet, this new technique requires objective evaluations. We have examined the controversies about the CDC dissection, distal common bile duct ligation, ductoplasty for hepatic duct stenosis, intrahepatic duct and common channel protein plug clearance, timing of surgery for antenatally diagnosed CDC, and the Roux loop length in CDC children. In the hands of experts, laparoscopic excision of the cyst and Roux-en-Y hepaticojejunostomy is a safe and effective approach. We provide our opinions on these issues based on our experience and publications. We conclude that the main outcomes comparable to those of the open surgery. The better wound cosmesis and reduction of surgical trauma are the advantages.
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Yamataka A, Lane GJ, Cazares J. Laparoscopic surgery for biliary atresia and choledochal cyst. Semin Pediatr Surg 2012; 21:201-10. [PMID: 22800973 DOI: 10.1053/j.sempedsurg.2012.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Minimally invasive surgery in children has evolved to the extent that complex procedures can be performed with safety and outcome comparable with open surgery, with the advantage of minimal scarring. Here we describe the latest laparoscopic techniques used by us at the Juntendo University Hospital, Japan, for treating biliary atresia and choledochal malformation, with presentation of our postoperative management and discussion of preliminary outcomes.
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Affiliation(s)
- Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
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Diao M, Li L, Cheng W. To drain or not to drain in Roux-en-Y hepatojejunostomy for children with choledochal cysts in the laparoscopic era: a prospective randomized study. J Pediatr Surg 2012; 47:1485-9. [PMID: 22901904 DOI: 10.1016/j.jpedsurg.2011.10.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 10/26/2011] [Accepted: 10/26/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND/PURPOSE Routine drain placement after choledochal cyst (CDC) excision and Roux-en-Y hepatojejunostomy (RYHJ) is commonly practiced to predict and prevent bile/pancreatic leaks and hemorrhage. Recently, laparoscopic excision of CDC has decreased postoperative morbidity. The necessity of drainage has been questioned. We undertook a prospective randomized trial to assess the need for drainage. METHOD Between 2009 and 2011, 121 CDC children were randomized into 2 groups before the laparoscopic RYHJ: drainage group (n = 61) and nondrainage group (n = 60). Patients without severe cyst inflammation, perforated bile peritonitis, common/left/right hepatic duct strictures requiring ductoplasty, or distal cyst deeply embedded in pancreas were included. Normal activity resumption, postoperative hospital stay, complications, and pain scores were analyzed. RESULTS One hundred patients were recruited according to the selection criteria (drainage/nondrainage, 50/50). Normal activity resumption was significantly faster and the postoperative hospital stay was significantly shorter in the nondrainage group. The pain score in the drainage group was significantly higher. On postoperative days 2 and 3, 14% and 38% of the nondrainage group patients were pain free, whereas all the drainage group patients still suffered from pain (P < .01 and P < .001, respectively). The median follow-up period was 12.5 months in the drainage group and 12 months in the nondrainage group. None of the patients developed bile/pancreatic/intestinal leaks. CONCLUSION With the laparoscopic approach, no drainage is needed after RYHJ for the majority of CDC children in expert hands. It minimizes postoperative pain and complications, and facilitates recovery.
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Affiliation(s)
- Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, PR China
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Liem NT, Pham HD, Dung LA, Son TN, Vu HM. Early and Intermediate Outcomes of Laparoscopic Surgery for Choledochal Cysts with 400 Patients. J Laparoendosc Adv Surg Tech A 2012; 22:599-603. [DOI: 10.1089/lap.2012.0018] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Nguyen Thanh Liem
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Hien Duy Pham
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Le Anh Dung
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Tran Ngoc Son
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Hoan Manh Vu
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam
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