title: Laparoscopic choledochal cyst excision, hepaticojejunostomy, and extracorporeal Roux-en-Y anastomosis: a technical skill and intermediate-term report in 62 cases.
abstract: BACKGROUND
  This study aimed to present the authors' technique and the intermediate-term outcome for laparoscopic choledochal cyst excision with Roux-en-Y hepatoenterostomy.
  
  
  METHODS
  This retrospective study investigated 62 children (39 girls and 23 boys) who had undergone laparoscopic resection of choledochal cyst. The average age of the children was 2.3 years. The retrospective data and the following investigations about type of choledochal cyst, surgical technique, conversion rate, morbidity, and mortality were analyzed.
  
  
  RESULTS
  Of the 62 patients, 43 (69.4%) showed type 1a choledochal cysts, 16 (25.8%) showed type 1c, 2 (3.2%) showed type 4a, and 1 (1.6%) showed type 4b. Total cyst excision could be performed for 51 of the patients (82.3%). The large cysts were opened on the front wall, then divided circumferentially in 29 cases. The small cysts did not need to be opened before excision in 22 cases. For 11 patients (17.7%), Lilly's (Surg Gynecol Obstet 146:254-256, 1978) technique was adopted, and for 5 patients with a huge cyst, the duodenum together with the head of the pancreas had to be mobilized for visualization of the cyst's lower limit. The hepatic duct was excised, and plastic operation of bile duct was performed for two patients. The mean operative time was 226±41.2 min. Eight patients needed blood transfusion, and conversion was required for one patient. The mean hospital stay was 8±1.5 days, and the mean follow-up period was 38 months. The overall morbidity rate was 8.2% (5/61) including bile leakage (n=1), adhesive small bowel obstruction (n=1), intestinal necrosis (n=1), and cholangitis (n=1). Inflammatory edema anastomotic narrowing occurred in one patient. None of the patients needed surgery due to anastomotic stricture.
  
  
  CONCLUSIONS
  Laparoscopic choledochal cyst excision, hepaticojejunostomy, and extracorporeal Roux-en-Y anastomosis can be safely and quickly performed for children, with satisfactory intermediate-term results. Extracorporeal Roux-en-Y anastomosis could shorten the operative time.
authors.affiliation: Department of Pediatric Surgery, Union Hospital of Huazhong University of Science and Technology, Wuhan, 430022, China. tshaotao83@yahoo.com.cn
authors.forename: Shao-Tao
authors.initials: ST
authors.lastname: Tang
authors.forename: Ying
authors.initials: Y
authors.lastname: Yang
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.forename: Yong-Zhong
authors.initials: YZ
authors.lastname: Mao
authors.forename: Shi-Wang
authors.initials: SW
authors.lastname: Li
authors.forename: Qiang-Song
authors.initials: QS
authors.lastname: Tong
authors.forename: Guo-Qing
authors.initials: GQ
authors.lastname: Cao
authors.forename: Zhi-Xiang
authors.initials: ZX
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000175:diagnosis / Q000601:surgery*; D002983:Clinical Competence; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008099:Liver / Q000601:surgery*; D008297:Male; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome