Laparoscopic-assisted total cyst excision of choledochal cyst and Roux-en-Y hepatoenterostomy

Purpose: The aim of this study was to describe the technical experience and outcome in laparoscopic-assisted total cyst excision of choleclochal cyst with Roux-en-Y hepatoenterostomy. Methods: Thirty-five patients with choleclochal cyst were studied. Their age ranged from 3 months to 9 years (average age, 3.6 years). The choleclochal cysts were cyst type in 33 cases and fusiform type in the other 2 cases. Four trocars were utilized with 3- to 5-mm instrumentation. Under laparoscopic guidance, the gallbladder and the dilated bile duct were excised completely. The Roux-en-Y jejunojejunostomy was performed extracorporeally by exteriorizing the jejunum through the extending umbilical incision (1.5 to 2 cm), and an end-to-side hepaticojejunostomy was carried out intracorporeally by the hand suture methods. Results: Average duration of operation was 4.3 hours (range, 3.5 to 7.6 hours), intraoperative blood loss was 5 to 10 mL, and 8 of the 35 patients had associated hepatic ductal stenosis and underwent laparoscopic excision of the cyst and ductoplasty. In 1 of the 8 cases, bile leak was noticed from day 1 through 26 postoperatively. The postoperative course was uneventful in the other 34 patients with a hospital postoperative stay ranging from 3 to 6 days. There were no postoperative complications in the 3-month to 11/2-year follow-up. Conclusions: Laparoscopic-assisted total cyst excision with Roux-en-Y hepatoenterostomy is feasible for the treatment of choledochal cyst in children. (C) 2004 Elsevier Inc. All rights reserved.