Laparoscopic total intracorporeal correction of choledochal cyst in pediatric population.
BACKGROUND
The laparoscopic correction of the choledochal cyst is an attractive treatment option. However, even the skilled surgeons do not prefer the intracorporeal jejunojejunal anastomosis due to the technical difficulties. In this article, we present the feasibility of laparoscopic total intracorporeal correction of the choledochal cyst, including the retrocolic Roux-en-Y hepaticojejunostomy and jejunojejunostomy.


METHODS
A prospective review of 6 cases of consecutive laparoscopic surgery for choledochal cyst in the pediatric population from March 2007 to April 2008 was performed. All patients underwent laparoscopic excision of a choledochal cyst and total intracorporeal Roux-en-Y reconstructions. The intracoporeal jejunojejunostomy was made by introducing an endoscopic gastrointestinal anastomosis device (Endo-GIA; US Surgical, Norwalk, CT) through the umbilical port with hand-sewn reinforcement. We evaluated the patient's age at the time of operation, time taken for total operation, time taken for jejunojejunostomy, and intra- and postoperative events.


RESULTS
All 6 cases were girls (age ranging from 4 months to 7 years). All had type I choledochal cyst. Five ports were utilized: one telescopic port at the umbilicus, one left subcostal port for liver retraction, two operating ports on the right flank and left side of the umbilicus, and one right-lower quadrant port for the assistant. The mean time for total operation was 275 + or - 58 minutes (range, 210-360). Total intracoroporeal jejunojejunostomy took 38 + or - 10 minutes (range, 25-55). All patients were symptom free during the median follow up of 3.5 months.


CONCLUSIONS
In the pediatric population with choledochal cyst, total intracorporeal Roux-en-Y hepaticojejunostomy and jejunojejunostomy during laparoscopic surgery is feasible without the need for exteriorization of the bowel.
Division of Pediatric Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon Anyang, 431-070 Korea. smahn@hallym.ac.kr
Soo Min
SM
Ahn
Jang Yong
JY
Jun
Woo Jung
WJ
Lee
Jung-Tak
JT
Oh
Seok Joo
SJ
Han
Seung Hoon
SH
Choi
Eui Ho
EH
Hwang
D000714:Anastomosis, Surgical; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D049448:Cholangiopancreatography, Magnetic Resonance; D015529:Choledochal Cyst / Q000601:surgery*; D004210:Dissection / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D011446:Prospective Studies; D013536:Suture Techniques