Laparoscopic excision of choledochal cyst and Roux-en-Y hepaticojejunostomy in symptomatic neonates.
OBJECTIVE
Choledochal cysts require surgical excision, preferably before the onset of cholangitis. Recently, it has become feasible to accomplish the excision laparoscopically in adults and older children. Yet, whether laparoscopic excision of choledochal cyst can be performed safely in symptomatic neonates with choledochal cyst is unclear. We herewith reviewed our experience of laparoscopic excision of choledochal cysts in neonates.


METHODS
We managed 9 neonates with choledochal cysts between April 2003 and February 2007. The choledochal cysts were excised laparoscopically. The Roux-en-Y hepaticojejunostomy was fashioned extracorporeally by exteriorizing the jejunum through the extended umbilical port site. End-to-side anastomosis between the common hepatic duct stump and Roux loop was carried out intracorporeally. The patients were followed up for an average of 26 months.


RESULTS
The patients presented with jaundice, pale stool, and deranged liver function tests. The diagnosis was confirmed with ultrasonography postnatally. The median operation time was 3.6 hours. There was no operative complication and no conversion. The blood loss was minimal. The recovery was uneventful, and the median hospital stay was 6 days. The liver function tests normalized 3 to 16 weeks postoperatively. No complication was detected at the follow-up visits.


CONCLUSIONS
Our preliminary results show that laparoscopic excision of choledochal cyst and Roux-en-Y hepaticojejunostomy in neonates is both feasible and safe. It curtails further complication of the cysts and reverses the derangement of liver function. In addition, the laparoscopic approach minimizes surgical trauma.
Liu
Shu-Li
SL
Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China.
Li
Long
L
Hou
Wen-Ying
WY
Zhang
Jun
J
Huang
Liu-Ming
LM
Li
Xu
X
Xie
Hua-Wei
HW
Cheng
Wei
W
D000714:Anastomosis, Surgical; D015529:Choledochal Cyst / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007582:Jejunostomy; D010535:Laparoscopy; D008099:Liver / Q000601:surgery; D008111:Liver Function Tests; D008297:Male; D012189:Retrospective Studies