title: Laparoscopic excision of choledochal cysts with total intracorporeal reconstruction.
abstract: OBJECTIVE
  There are numerous published reports of laparoscopic resection of choledochal cysts (CDCs), but almost all involve extracorporeal reconstruction of a biliary drainage system. We describe and evaluate the technique of laparoscopic CDC resection with total intracorporeal reconstruction.
  
  
  METHODS
  We reviewed all patients who underwent a laparoscopic CDC resection from March 2005 to January 2010 at Rocky Mountain Children's Hospital and Children's Hospital of New York-Presbyterian. We obtained data on operative time, characteristics of reconstruction, time to initiation of diet, length of stay, complications, and outcome.
  
  
  RESULTS
  Thirteen patients (median age 5 years, range 1-16) underwent a laparoscopic CDC excision with total intracorporeal reconstruction. Four ports were used in all cases and no patients required conversion to an open procedure. Operative time ranged from 130 to 325 minutes (median 240 minutes). Median time to initiation of diet was 1 day (range 1-4 days). Median length of stay was 5 days (range 4-8 days). There were no cases of cholangitis; however, 1 patient developed a small bowel obstruction requiring re-operation.
  
  
  CONCLUSIONS
  Laparoscopic resection of CDCs with total intracorporeal reconstruction is a safe and effective technique. The minimal handling of the bowel appears to minimize postoperative ileus, allows for early postoperative feeding and discharge.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Gander
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cowles
authors.forename: Erica R
authors.initials: ER
authors.lastname: Gross
authors.forename: Ari R
authors.initials: AR
authors.lastname: Reichstein
authors.forename: Anthony
authors.initials: A
authors.lastname: Chin
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Zitsman
authors.forename: William
authors.initials: W
authors.lastname: Middlesworth
authors.forename: Steven S
authors.initials: SS
authors.lastname: Rothenberg
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D006801:Humans; D007223:Infant; D007582:Jejunostomy; D010535:Laparoscopy; D007902:Length of Stay; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome