Jung-Man Namgoong, MD, JuYeon Lee, MD, SeongChul Kim, MD, PhD, DaeYeon Kim, MD, PhD. Department of Pediatric Surgery, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
Purpose: Laparoscopic excision of choledochal cyst (LEC) can be performed preferably in pediatrics and adults. However, LEC is not performed well in neonates because the safety and feasibility of neonatal LEC remain unknown. The purpose of this study is to evaluate our surgical outcomes of LEC in neonates.
Methods: More than 350 pediatric patients with choledochal cyst underwent surgical treatment in Asan Medical Center, South Korea. This is a retrospective study of 35 neonates who underwent excision of choledochal cyst between November 2001 and May 2016. The19 neonates underwent open excision of choledochal cyst(OEC) and 16 neonates underwent LEC. We compared the surgical method in neonate choledochal cyst between OEC and LEC. The perioperative and surgical outcomes that were reviewed included age, operative time, postoperative hospital stay, time to diet, and surgical complications. The patients were followed up for 42 months (range, 9-146 months).
Results: There was no difference in range of bile duct excision and manner of Roux-en-Y hepaticojejunostomy between OEC and LEC groups. There was no intraoperative complication in both groups and no open conversion in the LEC group except one case which was ruptured choledochal cyst. The median age of OEC and LEC groups were 13 days (range, 2-30) and 12.5 days (range, 6-26) and median body weight at the time of operation were 3.50kg (range, 2.64-4.22) and 3.32kg (range, 2.73-4.22), respectively. The median operative time was 163 minutes (range, 126-336) in OEC and 237.5 minutes (range, 150-351) in LEC groups and there was no significant difference between OEC and LEC groups (P=0.116). Intraoperative bleeding was minimal in both groups. The postoperative hospital-stay, time to start diet, and time to return to full feeding had no significant differences in both groups. After discharge, 5 of 19 (26%) OEC patients experienced readmission due to cholangitis and ileus, while there were none in the LEC group.
Conclusions: This study revealed that LEC had better prognosis compared to OEC. LEC provided an excellent cosmetic result. So we suggest LEC could be the treatment of choice for neonatal choledochal cyst. This is a small series, therefore future studies will have to include a larger number of patients and evaluate long-term follow-up.
Key word: Choledochal cyst, Laparoscopy, neonate
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87897
Program Number: P097
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster