National Medical University, Ukraine
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.