Department of Pediatric Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Department of Pediatric Gastroenterology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Eur J Pediatr Surg. 2021 Jun;31(3):286-291. doi: 10.1055/s-0040-1713933. Epub 2020 Jul 15.
Minimal access surgical approach to choledochal cyst (CC) is becoming a standard of care in pediatric age group. Robotic-assisted excision of CC is increasingly being practiced at centers which have access to the system. We present our experience and technique of hepaticoduodenostomy (HD). Over all initial experience, short-term outcomes and complications are also presented and discussed.
Patients with CC and undergoing robotic excision were retrospectively studied. Patients with active cholangitis, liver dysfunction, and perforated CC were excluded for robotic procedures. All included patients were preoperatively evaluated as per the defined protocol. They underwent excision of CC with HD. The duodenal anastomosis was done after limited mobilization and emphasis was laid on anastomosing the distal D2 part to the common hepatic duct. This prevents bile reflux into stomach. The follow-up evaluation was done for these patients. Hepatobiliary iminodiacetic acid (HIDA) scan for duodenogastric reflux (DGR) was done only if patients reported symptoms related to it.
A total of 19 patients (10 females) were studied. The mean age was 84 months. Type 1b was present in 12 patients and the rest were type IVb. Complete cyst excision with HD was done in all patients except conversion to open in one patient. The mean surgical time was 170 ± 40 minutes with console time of 140 ± 20 minutes. Median follow-up duration is 2.5 years (range: 3.5-0.5 years). HIDA scan was done in five patients who had reported epigastric pain. Of these five, one patient had a positive DGR. He is on conservative management.
Robot-assisted CC excision with HD is feasible as proven by the outcome of 19 patients presented in this series. HD is to be done away from pylorus in distal part of down curving D2. This particular step prevents DGR and is the most important point of technique in doing HD. The presented series is the first report of robotic excision of CC with HD. The robot is a facilitator for complex and difficult operations as CC excision and HD.
微创外科方法治疗胆总管囊肿（CC）在儿科中已成为一种标准的治疗方法。在有条件使用该系统的中心，越来越多的采用机器人辅助切除 CC。我们介绍了我们在施行肝肠吻合术（HD）方面的经验和技术。此外，我们还介绍并讨论了总体初步经验、短期结果和并发症。
对接受机器人切除 CC 的患者进行回顾性研究。患有活动性胆管炎、肝功能障碍和穿孔性 CC 的患者被排除在机器人手术之外。所有纳入的患者均根据既定方案进行术前评估。他们接受 CC 切除和 HD。在有限的游离后进行十二指肠吻合，并强调将远端 D2 部分与肝总管吻合，以防止胆汁反流至胃。对这些患者进行随访评估。只有在患者报告与胆汁反流相关的症状时，才进行肝胆放射性核素扫描（HIDA）以评估胆肠反流（DGR）。
共研究了 19 名患者（10 名女性）。平均年龄为 84 个月。12 名患者为 1b 型，其余为 4b 型。除 1 名患者转为开放性手术外，所有患者均行完全囊肿切除加 HD。手术时间平均为 170±40 分钟，控制台时间为 140±20 分钟。中位随访时间为 2.5 年（范围：3.5-0.5 年）。对 5 名报告上腹痛的患者进行了 HIDA 扫描。其中 1 名患者的 DGR 阳性。他正在接受保守治疗。
正如本系列 19 名患者的结果所示，机器人辅助 CC 切除加 HD 是可行的。HD 应在远端向下弯曲的 D2 的远离幽门处进行。这一特殊步骤可防止 DGR，是进行 HD 的最重要技术要点。本研究是机器人辅助切除 CC 加 HD 的首次报道。机器人是 CC 切除和 HD 等复杂和困难手术的辅助工具。
