title: Transition of Techniques to Treat Choledochal Cysts in Children.
abstract: BACKGROUND
  Traditionally open resection with hepaticojejunostomy (HJ) reconstruction has been the surgical treatment for cases of choledochal cyst. Our center has recently transitioned from open to laparoscopic and HJ to hepaticoduodenostomy (HD) as our preferred method of excision and biliary reconstruction. Our initial experience is presented here.
  
  
  METHODS
  A single-center retrospective chart review was performed from 2005 to 2014. All patients undergoing surgical treatment for choledochal disease were considered.
  
  
  RESULTS
  During the study period 18 patients had surgical treatment for choledochal cyst disease. The average age of all patients was 4.7 years (range, 2 months-15.5 years). Eleven of these patients had laparoscopic excision and reconstruction. Of these 11 patients, 7 had an HD anastomosis. Comparing the laparoscopic with the open group and the HD with the HJ group, there was no significant difference in operative time, estimated blood loss, time to regular diet, length of stay, or complication rate. Mean follow-up of 3.1 years revealed no documented cases of bile reflux or cholangitis. A recent adaptation in technique may improve ease of HD anastomosis. In this method, two strands of temporary monofilament suture cut to 8-10 cm each are tied extracorporeally. This knot is then placed on the outside of the medial corner. The anastomosis is then completed in a running fashion with the two strands and then secured intracorporeally at the lateral corner.
  
  
  CONCLUSIONS
  Laparoscopic choledochal cyst resection with both HJ and HD reconstruction appears safe and has equivalent outcomes to open procedures in our series.
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Brian G A
authors.initials: BG
authors.lastname: Dalton
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Gonzalez
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Dehmer
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Walter S
authors.initials: WS
authors.lastname: Andrews
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hendrickson
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002761:Cholangitis / Q000601:surgery; D015529:Choledochal Cyst / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D008099:Liver / Q000601:surgery*; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome