Speaker Biography

Oleg Godik

National Medical University, Ukraine

Title: Differential approach to choledochal cysts minimal invasive surgery in children

Oleg Godik
Biography:

Abstract:

Background: the view upon the surgical treatment of congenital biliary tract malformations has dramatically changed over the last decade. The approach tends to be laparoscopic in most cases. Nevertheless, in many studies it is stated that that the choice of laparoscopic procedures in choledochal cysts surgical treatment depends on the surgeons team skills. Materials and Methods: 18 patients with congenital choledochal cyst (CDC) were admitted to our hospital within the last 7 years. Their average age was 4 years (range 6 months- 12 years). There were  13 of the type I and 5 of type IV cysts according to Todani’s classification. 7 patients had large cysts up to 6-8cm. In all cases we used a 5mm camera positioned transumbilically, and 4 working trocars 5mm or 3mm- depending on the age of the patient. Patients were positioned in the “French” position. The average time of operation was 160 ±25 minutes. The Roux-en-Y jejunal loop was performed extracorporally through the umbilicus. A cyst excision with the Roux-en-Y hepaticojejunostomy was performed in 4 cases, and hepaticoduodenostomy in 14 cases. Results: We made a retrospective analysis of the laparoscopic treatment in children with CDC. All patients were presented with abdominal pain. In 4 cases pancreatitis was diagnosed, and three children had jaundice. The decision to perform a hepaticoduodenostomy after cyst resection was based on the small sizes of those cysts and their localization in the distal part of the common bile duct. There were no conversions in all the MIS cases. Analyzing intervention duration we distinguished that it takes lees time performing a hepaticoduadenostomy in comparison to hepaticojejunostomy by our team. However the average length of postoperative in-hospital stay was 6 days and did not essentially depend on the type of anastomosis performed. The follow-up was up to 3 years after operation with no stenosis, cholangitis, or other complications registered. Conclusion: Laparoscopic excision of CDC in children is an excellent treatment option in experienced hands. The type of reconstruction of the bile system - whether to perform a Roux-en-Y hepaticojejunostomy or a direct hepaticoduodenostomy depends on the cyst’s size and localization, and also the length of the bile duct after its excision.

 

Oleg Godik

National Medical University, Ukraine

Title: Differential approach to choledochal cysts minimal invasive surgery in children

Oleg Godik
Biography:

Abstract:

Background: Extrahepatic portal vein occlusion (EHPVO), remains one of the most common reasons of portal hypertension in pediatrics. More than a half of our patients (56,2%) sought for medical attention for the reason of acute variceal hemorrhage. Despite the improvement in and endoscopic control, most patients require a surgical procedure to be performed to achieve the elimination of bleeding or re-bleeding risks. Shunt surgery is usually indicated when the ultimate cause is possible to be treated, that results in the portal pressure normalizing with the following decreasing of the variceal bleeding risks.  We addressed contemporary outcomes of surgical treatment of portal hypertension in our hospital. Materials and methods: A retrospective study on 624 children with portal hypertension that underwent treatment in our Children’s Specialized Hospital “OHMADYT” during the last 15 years (from October 2003 to August 2018). The age of patients varied from 4 months to 18 years. The EHPVO presented in 74 % (n= 460) children. Umbilical vein catheterization 36,3 % (n= 167) was found to be the primary etiologic reason for the EHPVO development. Cavernous transformation of the portal vein persisted in 83,2 % (n= 383) children. More than half of the patients presented with acute variceal bleeding – 62% (n= 289). There were 136 (24,8 %) surgical procedures performed with devascularization operations (16 of them were Sugiura-Futagawa operation), 325 (59,4%) splenorenal shunts, 71 (12,9%) mesocaval shunts and 15 (2,7 %) mesoportal shunts. Results: Surgical procedures efficacy was evaluated according to the acute variceal bleeding episodes recuperation. The efficacy of devascularization operations was 61,1 %, of splenorenal shunt – 84,5 %, of mesocaval shunt – 92.5 % and 80 % for mesoportal shunt by this indicant. ConclusionIn comparison to of devascularization operations, shunt procedures in children with portal hypertension showed efficacy range 61,1 – 90,3 %, and therefore we consider them to be the better choice for such a patients.