Takanori Morikawa, MD, PhD, Takeshi Naitoh, MD, PhD, FACS, Hideo Ohtsuka, MD, PhD, Masaharu Ishida, MD, PhD, Takadate Tatsuyuki, MD, PhD, Takeshi Aoki, MD, PhD, Kei Nakagawa, MD, PhD, Hiroki Hayashi, MD, PhD, Fuyuhiko Motoi, MD, PhD, Michiaki Unno, MD, PhD. Department of surgery, Tohoku University Graduate School of Medicine
Background: The treatment of congenital biliary dilatation (CBD) and pancratobiliary maljunction (PBM), which contains the resection of the extrahepatic bile duct and bilioenteric anastomosis, is probably a good indication for minimally invasive surgery, because the rate of these diseases are higher in young women. Therefore, we have performed laparoscopic and robot-assisted surgery for CBD or PBM, and reported previously [J Robotic Surg 2015 9: 143-148].
Aim: We considered that minimally invasive approach would yield a profit to the patients with CBD or PBM, especially in short-term postoperative outcomes. Therefore, we performed comparative study between MIS and open surgery for the treatment of these diseases.
Patients and Methods: We have started laparoscopic resection of the extrahepatic bile duct for CBD under the approval of IRB from 2011, and robot-assisted procedure was approved in 2012. In our institution, the indication for these procedures were patients with type I CBD (Todani classification) and symptomatic PBM. Patients with type IV CBD and complicated PBM, which is classified as type III according to new Komi classification, were excluded and underwent open surgery. In this study, patient characteristics, intraoperative outcomes, and postoperative course of the patients who underwent minimally invasive or open surgery for CBD or PBM were retrospectively analyzed.
Results: Between January 2011 and September 2016, 18 patients with CBD or PBM underwent surgery in Tohoku University Hospital. Median age was 34 (16-70) years old and 16 patients were female. In these patients, 10 patients underwent MIS (laparoscopic: 5 patients, Robot-assisted: 5 patients), and 8 patients underwent open procedure. In patient’s backgrounds, age, sex, and diagnosis were comparable between open and MIS group, however, body mass index was significantly lower in open group. In intraoperative outcomes, median blood loss of MIS group was 10 (3-140) g and significantly smaller than open [200 (38-602) g], although operation time was comparable. In postoperative course, there was no difference in morbidity, and there was no mortality. However, postoperative hospital stay was significantly shorter than open group [9.5 (7-37) vs. 16.5 (11-20) days: p=0.035].
Conclusion: In selected patients, laparoscopic or robot-assisted surgery are feasible for the treatment of PBM and CBD, and will be more useful approach than open procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79595
Program Number: P125
Presentation Session: Poster (Non CME)
Presentation Type: Poster
