Early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 patients.
OBJECTIVE
The aim of this study is to report early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 cases.


METHODS
The operation was performed using four ports. The cystic duct was identified and divided. The liver was suspended by two stay-sutures: one on the round ligament and the other on the distal cystic duct. The choledochal cyst was isolated and removed completely, and biliary-digestive continuity was reestablished by hepaticoduodenostomy (HD) or hepaticojejunostomy (HJ).


RESULTS
From January 2007 to June 2011, 400 patients were operated on. There were 305 girls and 95 boys. Ages ranged from 1 month to 16 years (mean, 47.5±2.1 months). Cystic excision and HD were performed in 238 patients and HJ in 162 patients. The mean operating time was 164.8±51 minutes for the HD group and 220±60 minutes for the HJ group. Conversion to open surgery was required in 2 patients. There were no perioperative deaths. Postoperative biliary leakage occurred in 8 patients (2%), resolving spontaneously in 7 and requiring a second operation in 1 patient. The mean postoperative hospital stay was 6.4±0.3 days for the HD group and 6.7±0.5 days for the HJ group. Follow-up between 5 months and 57 months postdischarge (mean, 24.2±2.7 months) was obtained in 342 patients (85.5%). Cholangitis occurred in 5 patients (1.5%) in the HD group and 1 patient (0.6%) in the HJ group. Gastritis due to bilious reflux was 3.8% in the HD group.


CONCLUSIONS
Laparoscopic repair is a safe and effective procedure for choledochal cyst. The rate of cholangitis and anastomotic stenosis is low.
Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam. liemnhp@hotmail.com
Nguyen Thanh
NT
Liem
Hien Duy
HD
Pham
Le Anh
le A
Dung
Tran Ngoc
TN
Son
Hoan Manh
HM
Vu
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000601:surgery; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications; D013536:Suture Techniques; D016896:Treatment Outcome