Laparoscopic management for aberrant hepatic duct in children with choledochal cysts

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Aberrant hepatic ducts (AHD) are a common anomaly in children with choledochal cysts (CDC).
• Accurate identification and management of AHD are crucial for successful CDC treatment.
• Laparoscopic approaches are increasingly utilized for complex pediatric surgical conditions.

Purpose of the Study:

• To evaluate the efficacy of laparoscopic treatment for aberrant hepatic ducts (AHD) in children diagnosed with choledochal cysts (CDC).
• To assess the safety and outcomes of individualized laparoscopic surgical techniques based on AHD subtypes.

Main Methods:

• Retrospective review of 60 pediatric patients with CDC and AHD who underwent laparoscopic surgery (ductoplasty and hepaticojejunostomy) between 2001 and 2017.
• Classification of AHD variations into four subtypes, with surgical management tailored accordingly.
• Analysis of operative time, postoperative hospital stay, diet resumption, drainage duration, and complication rates.

Main Results:

• The mean age at surgery was 3.91 years. Most patients (58/60) had uneventful recoveries with an average operative time of 3.75 hours and a mean postoperative hospital stay of 6.02 days.
• Two patients with Type 2 anomaly required redo surgery for bile leaks, successfully managed laparoscopically.
• No major complications such as anastomotic stenosis, bile leaks, cholangitis, or Roux-loop obstruction were observed. Liver function and amylase levels normalized within one year.

Conclusions:

• Tailored laparoscopic management of AHD in CDC children, based on specific subtypes, is effective in preventing complications.
• Laparoscopic ductoplasty and hepaticojejunostomy represent an efficacious and safe treatment strategy for AHD in pediatric CDC patients.
• Individualized surgical planning is key to achieving optimal outcomes in this complex pediatric surgical condition.