Laparoscopic interventions in children with cystic bile duct dilations

   Aim. To evaluate the efficacy of laparoscopic interventions and to carry out a comparative analysis of various options for biliodigestive anastomoses in children with cystic dilation of bile ducts.

   Materials and methods. The results of laparoscopic interventions were retrospectively analyzed in 110 children aged 2 months – 17 years with cystic bile duct dilation. Conversion was required in 3 observations (2.7 %). Laparoscopically assisted or total laparoscopic extirpation of dilated bile ducts with hepaticojejunostomosis was performed in 83 patients (75.5 %), laparoscopic surgery with hepaticoduodenostomosis – in 24 patients (21.8 %).

   Results. The duration of surgery was significantly shorter when hepaticoduodenoanastomosis was formed. After laparoscopic interventions, early complications were revealed in 10 observations (9.3 %), including 7 cases (6.5 %) of hepatico-duoduodenoanastomosis failure in which relaparotomy was performed with reconstruction of both interintestinal and biliodigestive anastomosis. Late postoperative complications (anastomotic stenosis and adhesive intestinal obstruction) developed in 11 patients (10.2 %). In 5 observations (4.6 %), percutaneous transhepatic cholangiostomy with staged balloon dilation of hepaticojejunostomosis (n = 3) and endoscopic balloon dilation of hepaticoduodenostomosis with stenting (n = 2) were performed with a positive effect.

   Conclusion. Resection of bile ducts with cystic dilations with the formation of biliodigestive anastomosis can be performed both via video-assisted surgery and completely laparoscopically. Laparoscopic interventions in children with different variants of cystic dilation of the bile ducts prove to be effective and safe.

1. Soares K.C., Goldstein S.D., Ghaseb M.A., Kamel I., Hackam D.J., Pawlik T.M. Pediatric choledochal cysts: diagnosis and current management. Pediatr. Surg. Int. 2017; 33 (6): 637–650. doi: 10.1007/s00383-017-4083-6.

2. Troshina S.A., Stepanova Yu.A., Vishnevsky V.A. Multiple cholangiogenic liver abscesses with cystic transformation of bile ducts. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2020; 25 (4): 144–152. doi: 10.16931/1995-5464.20204144-152 (In Russian)

3. Farello G.A., Cerofolini A., Rebonato M., Bergamaschi G., Ferrari C., Chiappetta A. Congenital choledochal cyst: videoguided laparoscopic treatment. Surg. Laparosc. Endosc. 1995; 5 (5): 354–358. PMID: 8845978

4. Chan K.W., Lee K.H., Tsui S.Y., Mou J.W., Tam Y.H. Laparoscopic management of antenatally detected choledochal cyst : a 10-year review. Surg. Endosc. 2016; 30 (12): 5494–5499. doi: 10.1007/s00464-016-4912-z

5. Razumovskiy A.Yu., Mitupov Z.B., Kulikova N.V., Stepanenko N.S., Zadvernyuk A.S., Adler A.V., Shubin N.V. Bile duct reconstruction in choledochal malformations in children. Russian Journal of Pediatric Surgery. 2021; 25 (1): 4–10. doi: 10.18821/1560-9510-2021-25-1-4-10 (In Russian)

6. Patil V., Kanetkar V., Talpallikar M.C. Hepaticoduodenostomy for biliary reconstruction after surgical resection of choledochal cyst: a 25-year experience. Indian J. Surg. 2015; 77 (Suppl. 2): 240–244. doi: 10.1007/s12262-012-0783-2

7. Hamada Y., Hamada H., Shirai T., Nakamura Y., Sakaguchi T., Yanagimoto H., Inoue K., Kon M. Duodenogastric regurgitation in hepaticoduodenostomy after excision of congenital biliary dilatation (choledochal cyst). J. Pediatr. Surg. 2017; 52 (10): 1621–1624. doi: 10.1016/j.jpedsurg.2017.03.063

8. Kronfli R., Davenport M. Insights into the pathophysiology and classification of type 4 choledochal malformation. J. Pediatr. Surg. 2020; 55 (12): 2642–2646. doi: 10.1016/j.jpedsurg.2020.05.017

9. Almehdar A., Chavhan G.B. MR cholangiopancreatography at 3.0 T in children: diagnostic quality and ability in assessment of common paediatric pancreatobiliary pathology. Br. J. Radiol. 2013; 86 (1025): 20130036. doi: 10.1259/bjr.20130036

10. Lukovkina O.V., Sholokhova N.A., Sokolov Yu.Yu., Efremenkov A.M., Utkina T.V. Comparison of the possibilities of three-dimensional visualization and standard magnetic resonance cholangiopancreatography in the diagnosis of choledochal cysts in children. Pediatrician's Practice. 2023; 3: 64–68. (In Russian)

11. Ishibashi H., Shimada M., Kamisawa T., Fujii H., Hamada Y., Kubota M., Urushihara N., Endo I., Nio M., Taguchi T., Ando H. Japa nese Study Group on Congenital Biliary Dilatation (JSCBD). Japanese clinical practice guidelines for congenital biliary dilatation. J. Hepatobiliary Pancreat. Sci. 2017; 24 (1): 1–16. doi: 10.1002/jhbp.415

12. Takuma K., Kamisawa T., Hara S., Tabata T., Kuruma S., Chiba K., Kuwata G., Fujiwara T., Egashira H., Koizumi K., Fujiwara J., Arakawa T., Momma K., Igarashi Y. Etiology of recurrent acute pancreatitis, with special emphasis on pancreaticobiliary malformation. Adv. Med. Sci. 2012; 57 (2): 244–250. doi: 10.2478/v10039-012-0041-7

13. Santore M.T., Behar B.J., Blinman T.A., Doolin E.J., Hedrick H.L., Mattei P., Nance M.L., Adzick N.S., Flake A.W. Hepaticoduodenostomy vs hepaticojejunostomy for reconstruction after resection of choledochal cyst. J. Pediatr. Surg. 2011; 46 (1): 209–213. doi: 10.1016/j.jpedsurg.2010.09.092

14. Kozlov Iu.A., Novozhilov V.A., Veber I.N., Kovalkov K.A., Chubko D.M., Rasputin A.A., Baradieva P.J., Timofeev A.D., Zvonkov D.A., Us G.P., Kuznetsova N.N., Rasputina N.V., Kononenko M.I. Laparoscopic hepaticoduodenostomy as a method of treatment of choledochal cysts in children. Endoscopic Surgery. 2018; 24 (2): 43–47. doi: 10.17116/endoskop201824243 (In Russian)

15. Morrison P., Miedema B.W., Kohler L., Kelly K.A. Electrical dysrhythmias in the Roux jejunal limb: cause and treatment. Am. J. Surg. 1990; 160 (3): 252–256. doi: 10.1016/s0002-9610(06)80017-6

16. Tanaka R., Nakamura H., Yoshimoto S., Okunobo T., Satake R., Doi T. Postoperative anastomotic stricture following excision of choledochal cyst : a systematic review and meta-analysis. Pediatr. Surg. Int. 2022; 39 (1): 30. doi: 10.1007/s00383-022-05293-x

17. Li S., Wang W., Yu Z., Xu W. Laparoscopically assisted extrahepatic bile duct excision with ductoplasty and a widened hepaticojejunostomy for complicated hepatobiliary dilatation. Pediatr. Surg. Int. 2014; 30 (6): 593–598. doi: 10.1007/s00383-014-3501-2

18. Gander J.W., Cowles R.A., Gross E.R., Reichstein A.R., Chin A., Zitsman J.L., Middlesworth W., Rothenberg S.S. Laparoscopic excision of choledochal cysts with total intracorporeal reconstruction. J. Laparoendosc. Adv. Surg. Tech. A. 2010; 20 (10): 877–881. doi: 10.1089/lap.2010.0123

19. Madadi-Sanjani O., Wirth T.C., Kuebler J.F., Petersen C., Ure B.M. Choledochal cyst and malignancy: a plea for lifelong follow-up. Eur. J. Pediatr. Surg. 2019; 29 (2): 143–149. doi: 10.1055/s-0037-1615275