A role for laparoscopic approach in the treatment of biliary atresia and choledochal cysts (original) (raw)
Related papers
Annals of Surgical Treatment and Research
To begin with, choledochal cysts were found to be a congenital biliary tract anomaly, first described by Vater and Ezler [1] in 1723, and classified by Todani et al. [2] in 1977. In this sense, choledochal cysts occur more frequently in Asians than in Westerners and are known to have higher incidence in women than men [3]. It is often diagnosed in young children, and the main symptoms are abdominal pain, the presence of a palpable mass, and jaundice. This condition has the potential for malignancy transformation and usually requires surgical treatment. In these cases, it is standard to perform a Roux-en-Y
Revista do Colegio Brasileiro de Cirurgioes, 2018
to describe the first 13 cases of laparoscopic correction of common bile duct cyst in the Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil. we performed a retrospective analysis of medical records of cases of choledochal cyst operated by laparoscopy between March 2014 and September 2016. of the 13 patients, eight were female and the mean age at surgery was 7.8 years. The most common symptom was abdominal pain. The hepaticoduodenal anastomosis was the most used reconstruction technique, in 84.6% of the cases. There was no conversion to laparotomy or intraoperative complications. Only one patient presented anastomotic fistula and was reoperated by laparotomy. All patients were followed up in an outpatient clinic, were asymptomatic and had no episode of cholangitis after surgery, with a mean follow-up of 16 months. laparoscopy is a safe method to correct choledochal cysts, even in younger children, with low rates of complications and low rates of conversion to open surgery when perf...
Early outcomes of laparoscopic surgery for biliary atresia
Journal of Pediatric Surgery, 2010
The aim of the study was to present early outcomes of the laparoscopic technique for biliary atresia with some technical modifications. Materials and Methods: We reviewed charts of all patients with biliary atresia who underwent laparoscopic portoenterostomy from July to December 2008. There were 11 patients with biliary atresia, including 5 boys and 6 girls. The operation was carried out using 4 trocars. The liver was elevated by 2 transcutaneous stay sutures: one on the round ligament and the other on the gallbladder remnant. The left and right hepatic arteries and portal veins were dissected and retracted laterally by 2 transcutaneous sutures to expose the liver hilum. A stay suture was placed on fibrotic tissue at the liver hilum to facilitate its maximal removal. A jejunal end-to-side anastomosis was constructed extracorporeally. Portoenterostomy was carried out laparoscopically. Results: Mean operative time was 245 ± 31 minutes. No patient required conversion. There were no operative deaths. Blood loss during operation was minimal. One patient died on day 65 after operation because of intractable hepatic liver. Follow-up after discharge from 10 to 16 months revealed that 6 patients still survived and 4 patients died. One patient died because of milk aspiration at 12 months of age. Three patients died because of repeated cholangitis and liver failure at 10, 10, and 14 months, respectively. Conclusion: With a modified laparoscopic technique, good early outcomes of laparoscopic surgery for biliary atresia were achieved.
Biliary atresia and biliary cysts
Baillière's Clinical Gastroenterology, 1997
The authors present a review of the classification, aetiology, presentation, treatment and long-term outcome of children and adults with biliary atresia and choledochal cyst disease. Biliary atresia should be suspected in any infant with jaundice beyond the second week of life. Although the aetiology and pathogenesis remain unclear, early management with portoenterostomy has significantly improved the course of this disease. Recent advances in immunosuppression have made liver transplantation a valuable and necessary adjunct to biliary bypass. With choledochal cyst disease, adults, unlike children, often present with acute biliary tract symptoms or pancreatitis. The treatment of choice remains extrahepatic cyst excision and biliary bypass. This treatment has excellent long-term results that minimize the development of malignancy.
Journal of pediatric surgery, 2015
The objective of the study is to evaluate the outcome of laparoscopic Kasai portoenterostomy for type III biliary atresia in children. A total of 95 type III biliary atresia patients were treated at the Capital Institute of Pediatrics between September 2009 and August 2011. The patients were randomized into 2 groups preoperatively: the laparoscopic group (LP group, n=48) and the open group (OP group, n=47). In the LP group, 4 patients were converted to open operations, whereas the remaining 44 patients in the LP group and 47 patients in the OP group were included in the study. The gender distribution and age of the LP group did not differ from those of the OP group (LP group F/M 21/23, median age 61.5days, OP group F/M 24/23, median age 67days, P=0.75 and 0.11). The operation time in the LP group was significantly longer than that in the OP group (median 169.5min vs 146min, P<0.01). Intraoperative blood loss in the LP group was significantly lower than in the OP group (median 10m...
Complete Laparoscopic Management of Choledochal Cyst: Report of Two Cases
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2002
Background: Choledochal cyst is a rare congenital anomaly of the biliary tract. With increased familiarity with the laparoscopic anatomy of the biliary tract and advances in minimally invasive techniques, surgeons have ventured further to operate on technically difficult cases such as choledochal cyst that were until recently managed by laparotomy. Patients and Methods: We present our experience with two female patients aged 14 years and 26 years with choledochal cyst (type I according to the Alonzo-Lej classification) that were successfully excised with construction of a Roux-en-Y hepaticojejunostomy entirely laparoscopically. Results: Both patients had an uneventful recovery, with no major morbidity. The first patient had a bile leak, which resolved over 5 days. Both were discharged by the 5 th postoperative day. Conclusion: Laparoscopic management of choledochal cyst is feasible although technically difficult and may be performed in specialized institutes dealing with advanced laparoscopic surgery.
Biliary atresia with a “cyst at porta”: management and outcome as per the cholangiographic anatomy
Pediatric Surgery International, 2007
The purpose of this study is to classify biliary atresia (BA) with a ''cyst at porta'' according to the cholangiographic anatomy and to define management strategy and outcome in each group. A cyst at porta was identified in 13 of 58 babies (22.4%) with BA at first presentation. The cholangiographic anatomy was classified as; Group A (n = 7), type III BA with extrahepatic cyst; Group B (n = 2), type I or II BA with extrahepatic biliary cyst; and Group C (n = 4), type I or II BA with both extrahepatic and intrahepatic biliary cysts. The remaining 45 patients were comprised of type III BA without a cyst. A Kasai's portoenterostomy (PE) was performed for all Group A patients. Groups B and C were treated by hepaticojejunostomy (n = 5) or portoenterostomy (n = 1). All 45 patients with type III BA without a cyst were treated by a Kasai's PE. The median age at surgery was 92 days (ranges 28-342 days). There were three early post-operative deaths, all in patients with type III BA without cyst. Overall 18/55 (32.7%) patients achieved a jaundice free state. In Group A, 5/7 (71.4%) patients had bile flow, 2/7 (28.6%) are anicteric and 2/7(28.6%) had 1-2 episodes of post-operative cholangitis. In Group B, both patients are anicteric and none had post-operative cholangitis. In Group C, all four babies had bile flow but, significant morbidity because of recurrent severe cholangitis. Only one patient reached a jaundice free state. Of the remaining 42 patients with type III BA without a cyst, 27 (64.3%) had bile flow, 13 (31%) became jaundice free and 14 (33.3%) have had 1-2 episodes of post-operative cholangitis. In conclusion, thirteen of 58 (22.4%) babies with BA had a ''cyst at porta'' at first presentation in this series. The outcome was most satisfactory in type I BA without intrahepatic cystic dilatation (Group B) in terms of achieving a jaundice free state and freedom from recurrent cholangitis. However, intrahepatic biliary cysts (Group C) were associated with recurrent severe cholangitis and a poor eventual outcome despite a good initial bile flow. The outcome in type III BA with extrahepatic cyst was comparable to type III BA without cyst.
Background/Purpose: Primary cyst excision combined with biliary reconstruction is the standard treatment of choledochal cysts. Roux-en-Y hepatico-jejunostomy (RYHJ) or hepatico-dudenostomy (HD) is the most commonly used techniques for biliary reconstruction. This study was undertaken to compare the operative details and postoperative functional results of patients treated with either RYHJ or HD on both early and long term follow up. Materials and Methods: This retrospective study included 27 patients with choledochal cysts, who were treated during the period from 1993 to 2005. Complete excision of the extra-hepatic cysts was done in all patients. The study population was classified into two groups according to the method used for biliary reconstruction. Group 1 included 18 patients who undergone RYHJ, while group 2 included 9 patients treated with HD. All patients were studied as regard to the details of clinical presentation, diagnostic tools, operative details, and outcome. Statis...
Diagnosis and modern medical-surgical tactics in treatment of biliary atresia in children
Zenodo (CERN European Organization for Nuclear Research), 2020
Background: Biliary atresia (BA) is a serious pediatric condition that tends to progress to cirrhosis, liver failure, and death within a short time. It is the result of a continuous inflammatory, sclerosing, destructive process in the biliary tract and the most common indication for liver transplantation. Material and methods: The study included 46 patients up to 1 year of age hospitalized with cholestasis syndrome in IMSP IM and C, during the years 2014-2019. The basic methods in the diagnosis of BA were the biochemical examination, FGDS, USG doppler dupplex color of the biliary system before and after the meal intake, MRI with cholangiography, dynamic hepatobiliary scintigraphy. Results: Following the analysis of clinical and paraclinical results, surgical pathology was excluded in 25 patients, the diagnosis of BA was established in 11 cases. 6 patients with BA underwent Kasai surgical intervention , a primary liver transplant was performed in 3 cases, and 2 patients died before the surgery. Conclusions: Portoenteroanastamosis (Kasai operation) performed as early as possible (up to 60 days postnatal) considerably increases life expectancy. The embryonic form of BA is a severe condition that is indicated for the initial liver transplant.The prognosis of untreated biliary atresia is unfavorable, leading to the death of most children in the first 2 years of life due to liver failure. In decopensated late-diagnosed cases, liver transplantation remains the only treatment option.
Early and Intermediate Outcomes of Laparoscopic Surgery for Choledochal Cysts with 400 Patients
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2012
Objective: The aim of this study is to report early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 cases. Patients and 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.