Lee Changhoon, Byun Jeik, Ko Dayoung, Yang Hee-Beom, Youn Joong Kee, Kim Hyun-Young
Department of Surgery, Seoul National University Hospital, Seoul, Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Ann Surg Treat Res. 2021 Mar;100(3):186-192. doi: 10.4174/astr.2021.100.3.186. Epub 2021 Feb 26.
Cyst excision with hepaticojejunostomy has been the classic procedure for treating choledochal cysts, and the use of laparoscopic treatment has been favored recently. The purpose of this study was to compare the long-term biliary complication of laparoscopic operation with open surgery for choledochal cyst presenting in children.
A retrospective study comparing the laparoscopic and open procedures was performed in 185 patients with choledochal cyst in a single children's hospital. There were 109 patients who were operated with open surgery, and 76 patients operated with laparoscopic surgery. The primary outcome was long-term biliary complications and the secondary outcome included operative time, intraoperative transfusion, length of hospital stay, and other late postoperative complications.
In the patient's demographics, there was no significant difference between the 2 groups. Notably, it was shown that the operative time was longer in the laparoscopic group. The number of patients requiring blood transfusion intraoperatively was lower in the laparoscopic group. It was noted that the hospital stay was not statistically different. The duration to resumption of diet and duration of drainage were longer in the laparoscopic group. Biliary complications were shown to be significantly higher in the open group. The risk factor for long-term biliary complications was noted with the intraoperative transfusion.
The use of a laparoscopic choledochal cyst excision with hepaticojejunostomy is a safe and feasible technique in a young patient. The long-term biliary complication was lower compared to open surgery, rendering this a good option for pediatric patients.
囊肿切除并肝管空肠吻合术一直是治疗胆总管囊肿的经典术式，近年来腹腔镜治疗备受青睐。本研究旨在比较儿童胆总管囊肿腹腔镜手术与开放手术的长期胆道并发症。
在一家儿童医院对185例胆总管囊肿患者进行了一项比较腹腔镜和开放手术的回顾性研究。其中109例行开放手术，76例行腹腔镜手术。主要结局是长期胆道并发症，次要结局包括手术时间、术中输血、住院时间及其他术后晚期并发症。
在患者人口统计学方面，两组之间无显著差异。值得注意的是，腹腔镜组手术时间较长。腹腔镜组术中需要输血的患者数量较少。住院时间在统计学上无差异。腹腔镜组恢复饮食的时间和引流时间较长。开放组的胆道并发症明显更高。术中输血是长期胆道并发症的危险因素。
对于年轻患者，采用腹腔镜胆总管囊肿切除并肝管空肠吻合术是一种安全可行的技术。与开放手术相比，长期胆道并发症较低，这使其成为儿科患者的一个良好选择。
