Laparoscopic Treatment of Congenital Choledochal Cysts in Children

Background: In the last decade the view upon surgical treatment of congenital biliary tract malformations has significantly changed. Today the approach tends to be laparoscopic in most cases. Materials and Methods: In the last 5 years we had admitted 5 patients to our clinics with a congenital choledochal cyst (CHC). The median age was 4 years (range 11 months- 12 years). There were three patients having the type I and two having type IV cysts according to Todani’s classification. Three patients had large cysts up to 6-8 cm. Patients were positioned in the “French” position. For all the cases we used a 5 mm camera positioned transumbilicaly, and 4 working trocars 5 mm or 3 mm- depending on the age of the patient. The average time of operation was 160 ± 25 minutes. The Roux-en-Y jejunal loop was carried out extracorporaly through the umbilicus. In three cases we performed a cyst excision with a Roux-en-Y hepaticojejunostomy, and in two cases we performed hepaticoduodenostomy. Results: We made a retrospective analysis of the laparoscopic treatment of children with CHC. There were no conversions in all the MIS cases. While analyzing the time of operation we came to see that performing a hepaticoduadenostomy instead of hepaticojejunostomy shortens the time of operation by 1/3. However the post-op hospital stay did not depend on which type of anastomosis was performed, the average of which was 6 days. The follow- up was up to 3 years after operation with no stenosis, cholangitis, or other complications. Conclusion: Laparoscopic resections of CHC in children are an excellent treatment option. Selecting the type of reconstruction of the bile system weather to perform a Roux-en-Y hepaticojejunostomy or a direct hepaticoduodenostomy depends on the size and localization of the cyst, and also the length of the hepatic duct remnant after resection.