Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
Eur J Pediatr Surg. 2022 Dec;32(6):521-528. doi: 10.1055/s-0042-1749435. Epub 2022 Jun 28.
Numerous studies from Asian countries, including large collectives, have reported excellent results after laparoscopic resection of choledochal malformation (CM). However, the role of laparoscopic CM resection is still controversial outside Asia. We aimed to analyze the outcome of laparoscopic CM resection in our institution and to compare our outcome with the data reported in the literature.
All patients who underwent laparoscopic CM resection in our pediatric surgical department from 2002 to 2019 were retrospectively analyzed for surgical details and postoperative complications, which were graded according to the Clavien-Dindo classification. A systematic literature search identified all reports on over 10 cases of laparoscopic pediatric CM resection and surgical details, follow-up, and complication rates were extracted.
Fifty-seven patients (72% female) with a mean age of 3.6 + 4.1 years underwent laparoscopic CM resection in our department. Conversion rate was 30%. Total complication rate was 28%. The rate of major complications (Clavien-Dindo grade III or more) was 16% and included stricture of the biliodigestive or enteric anastomosis ( = 4), adhesive ileus ( = 3), portal vein thrombosis ( = 1), and recurrent cholangitis with consecutive liver transplantation ( = 1). With increasing experience, complication rates decreased. The majority of publications on laparoscopic CM resections originated from Asia ( = 36) and reported on low complication rates. In contrast, publications originating from non-Asian countries ( = 5) reported on higher complications following laparoscopic CM resection.
Our data indicate that laparoscopic CM resection can be safely performed. The learning curve in combination with the low incidence calls for a centralization of patients who undergo laparoscopic CM resection. There seems to be a discrepancy on complications rates reported from Asian and non-Asian countries following laparoscopic CM resection.
来自亚洲国家的大量研究，包括大规模研究，报告了腹腔镜胆总管畸形（CM）切除术后的优异结果。然而，在亚洲以外，腹腔镜 CM 切除的作用仍存在争议。我们旨在分析我们机构中腹腔镜 CM 切除的结果，并将我们的结果与文献中的数据进行比较。
回顾性分析了 2002 年至 2019 年期间在我院小儿外科行腹腔镜 CM 切除术的所有患者的手术细节和术后并发症，并发症根据 Clavien-Dindo 分级进行分级。系统文献检索确定了所有超过 10 例腹腔镜小儿 CM 切除术的报告，并提取了手术细节、随访和并发症发生率。
57 例（72%为女性）患者，平均年龄为 3.6±4.1 岁，在我院行腹腔镜 CM 切除术。中转率为 30%。总并发症发生率为 28%。严重并发症（Clavien-Dindo 分级 III 级或以上）发生率为 16%，包括胆肠或肠吻合口狭窄（=4）、粘连性肠梗阻（=3）、门静脉血栓形成（=1）和复发性胆管炎伴连续肝移植（=1）。随着经验的增加，并发症发生率降低。腹腔镜 CM 切除术的大多数出版物来自亚洲（=36），报告的并发症发生率较低。相比之下，来自非亚洲国家的出版物（=5）报告腹腔镜 CM 切除术后的并发症发生率较高。
我们的数据表明腹腔镜 CM 切除术可以安全进行。学习曲线和低发生率要求对接受腹腔镜 CM 切除术的患者进行集中治疗。亚洲和非亚洲国家报告的腹腔镜 CM 切除术后并发症发生率似乎存在差异。
