Laparoscopic Cyst Excision and Roux-Y Hepaticojejunostomy for Children with Choledochal Cysts in China: a Multicenter Study

Aims: Laparoscopic hepaticojejunostomy (LH) for children with choledochal cyst (CDC) has become feasible and popular recently. The purpose of this study is to evaluate the safety and efficacy of LH for CDC in a large multicenter series.

Patients And Methods: Medical records of 956 consecutive patients who underwent LH for CDC at seven academic institutions from June 2001 to May 2012 were retrospectively analyzed. Ultrasonography, upper gastrointestinal contrast studies, and laboratory tests were performed during the follow-up period.

Results: A total of 956 patients of CDC treated with LH were identified and included in this study. Of these patients, there were no significant differences in age, gender ratio, and the subtypes of CDC among the seven centers. The operative time of all patients decreased significantly as time went by. Interestingly, the centers that began to perform LH earlier, like cohort A, B, and C, took much more time in the initial cases than the later centers. The postoperative complications included 12 (1.3 %) intra-abdominal fluid collection, 6 (0.6 %) anastomotic stenosis, 14 (1.5 %) bile leak, 8 (0.8 %) Roux loop obstruction and 4 (0.4 %) gastrointestinal bleeding, and one case developed intrahepatic stone formation; two mortalities occurred; one died of hyperkalemia, and the other one died of postoperative bleeding. No other complication occurred during the mean follow-up of 5.7 years (ranged from 4 month to 11 years).

Conclusions: We reported a multi-institutional series of LH in children with CDC. Our findings suggested that LH represents a feasible treatment option for CDC by offering reliable middle and long-term outcome, low surgical morbidity.