Fanny Yeung, Patrick Ho Yu Chung, Adrian Chi Heng Fung, Kenneth Kak Yuen Wong, Paul Kwong Hang Tam, Professor. Queen Mary Hospital
Introduction: Choledochal cysts are congenital dilations of the biliary tree. Complete cyst excision and biliary-enteric reconstruction have been the standard operations for choledochal cyst. In our centre, more than 95% of choledochal cyst excision was performed laparoscopically.
Majority of the studies describe laparoscopic assisted reconstruction of the Roux-en-Y hepaticojejunostomy (HJ), however only a few have studied laparoscopic hepaticoduodenostomy (HD) as an alternative method of biliary-enteric reconstruction.
In this study, we compared both the short-term and longer-term outcomes between laparoscopic HJ and HD reconstruction following choledochal cyst excision at our institution.
Methods: We performed a retrospective analysis of 54 children who had undergone laparoscopic choledochal cyst excision and biliary-enteric reconstruction between October 2004 and April 2018. Short-term outcomes including conversion, complications such as anastomotic leakage and bleeding, and hospital stays were analysed. Long-term outcomes including contrast reflux into biliary tree, cholangitis, anastomotic strictures and need of reoperation were analysed.
Results: Of the 54 patients, 21 of them underwent laparoscopic HD and 33 underwent laparoscopic Roux-en-Y HJ anastomosis reconstruction. There were no significant differences in gestation, gender, age at operation, antenatal diagnosis and Todani type of choledochal cyst between HD and HJ group.
Operative time was significantly shortened in HD group (186 minutes vs 367 minutes, p= 0.001). Conversion to open surgery was significantly higher in HJ group (64% vs 5%, p=0.001). Median intensive care unit (0.5 vs 1.9 days, p = 0.001) and hospital stay (7.5 vs 9.0 days, p = 0.019) were significantly shorter in HD group than HJ group. There were no perioperative deaths. There was no significant difference in anastomotic leakage requiring reoperation (p = 0.743) and anastomotic stricture (p=0.097).
Postoperative upper contrast study showed contrast reflux into biliary tree in 56% of HD group patients and 15% of HJ group patients (p= 0.024). Nevertheless, there were no significant differences in other long-term outcomes including cholangitis (p= 0.061), symptoms of recurrent abdominal pain (p=0.071), or need of reoperation (p=0.236). All patients had normal serum bilirubin level postoperative.
Conclusions: Laparoscopic excision of choledochal cyst with HD reconstruction is safe, feasible with better short-term outcomes than Roux-en-Y HJ reconstruction. Although HD group patients had a higher chance of contrast reflux into biliary tree radiologically, none of these patients experienced cholangitis clinically in the long-term at median follow-up duration of 54 months (IQR 13.75 to 84 months). Other long-term outcomes are comparable between HD and HJ groups.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93838
Program Number: S017
Presentation Session: HPB
Presentation Type: Podium