title: Laparoscopic resection of congenital choledochal cyst, choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis.
abstract: BACKGROUND
  The feasibility of laparoscopic resection of choledochal cyst and hepaticojejunostomy in children is still unclear. This report presents the author's experience with a first series of patients.
  
  
  METHODS
  Data from 11 consecutive children (median age 17.5 months, SD 22, range 2 to 70) with choledochal cyst scheduled for laparoscopy were collected prospectively. There were nine type I and 2 type V cysts according to Todani's classification. All except one patient had intermittent jaundice or recurrent pancreatitis. The laparoscopic technique included excision of the cyst. A Roux-en-Y anastomosis was constructed after exteriorization of the small bowel via the infraumbilical trocar incision. After repositioning of the bowel an end-to-side hepaticojejunostomy was carried out laparoscopically.
  
  
  RESULTS
  The procedures were carried out in nine children without intraoperative events and a median duration of 289 min (SD 62). In two patients, the operation was converted after 60 and 90 min due to a lack of overview at the dorsal margin with problems in separation of the portal vein. Oral food intake was started within 2 days and tolerated well in all except one patient, in whom biliar fluid from the drain led to laparoscopic reevaluation on day 1. A small leak was resutured and the patient was discharged on day 5. In one patient, recurrent cholangitis and a dilated Roux-en-Y loop led to correction of some kinking of the loop via laparotomy after 3 months. All other patients are well with bile-stained stools after a mean follow-up of 13 months.
  
  
  CONCLUSIONS
  Laparoscopic resection of congenital choledochal cyst and choledochojejunostomy in children is feasible. We feel that there is a considerable learning curve with the technique. Future studies will have to prove the feasibility of laparoscopic Roux-en-Y bowel anastomosis without the need for bowel exteriorization.
authors.affiliation: Department of Pediatric Surgery, Medical University Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. ure.benno@mh-hannover.de
authors.forename: B M
authors.initials: BM
authors.lastname: Ure
authors.forename: F
authors.initials: F
authors.lastname: Schier
authors.forename: A I
authors.initials: AI
authors.lastname: Schmidt
authors.forename: R
authors.initials: R
authors.lastname: Nustede
authors.forename: C
authors.initials: C
authors.lastname: Petersen
authors.forename: N K
authors.initials: NK
authors.lastname: Jesch
mesh_terms: D000713:Anastomosis, Roux-en-Y; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000601:surgery*; D002768:Choledochostomy; D006801:Humans; D007223:Infant; D010535:Laparoscopy