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Laparoscopic Hepatic Ductoplasty in Pediatric Choledochal Cyst: What Is the Role, Feasibility, and
Jarruphong Noitumyae1,2, Jarumon Amnuaypol1, Chanokkamol Kiataramkul1
1Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
Insights
Laparoscopic hepatic ductoplasty is a safe and effective treatment for pediatric choledochal cysts with hepatic duct stenosis, reducing complications like hepatolithiasis and recurrent cholangitis. This minimally invasive approach offers comparable outcomes to open surgery.
Area of Science:
- Hepatobiliary surgery
- Minimally invasive surgery
- Pediatric surgery
Background:
- Pediatric choledochal cysts with hepatic duct stenosis can lead to serious complications such as hepatolithiasis, recurrent cholangitis, and pancreatitis.
- Laparoscopic hepatic ductoplasty is a potential surgical approach to prevent these adverse outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the characteristics of hepatic duct stenosis.
- To evaluate the efficacy and safety of laparoscopic hepatic ductoplasty.
- To compare outcomes of laparoscopic versus open surgical techniques.
Main Methods:
- Systematic review and meta-analysis of published studies from PubMed, Scopus, and Cochrane Library (January 1985 - April 2022).
- Inclusion of 9 studies with 412 pediatric patients.
- Analysis of hepatic duct stenosis locations, characteristics, laparoscopic techniques, and patient outcomes.
Main Results:
- Hepatic duct stenosis commonly occurred at the confluence of the left and right hepatic ducts (43.1%) with membranous/septum appearance (44.7%).
- Laparoscopic techniques included Roux-en-Y hepaticojejunostomy (28.5%), membrane excision (26.5%), and mixed approaches (45.0%).
- Outcomes showed low rates of minor bile leakage (3.8%) and minimal bleeding, with no significant difference compared to open surgery for hepatolithiasis, anastomosis stricture, or recurrent cholangitis.
Conclusions:
- Laparoscopic hepatic ductoplasty is a safe and effective procedure for pediatric choledochal cysts with hepatic duct stenosis.
- The procedure effectively decreases the incidence of hepatolithiasis, anastomosis stricture, and recurrent cholangitis.
- While associated with a trend towards longer operating times, laparoscopic surgery demonstrates comparable efficacy to open techniques.
Abstract:
The pediatric choledochal cyst with hepatic duct stenosis occurs postoperative hepatolithiasis, recurrent cholangitis, or pancreatitis. The laparoscopic hepatic ductoplasty can prevent these incidences. To determine the characteristic of hepatic duct stenosis, laparoscopic treatment, and outcomes in systematic review and meta-analysis. We searched the published studies on PubMed, Scopus, and Cochrane Library databases from January 1985 to April 2022 in English language. This protocol was registered to PROSPERO (CRD42022332145). Nine published studies and 412 patients were included. The meta-analysis revealed that the locations were the confluence of the left and right hepatic ducts 43.1%, the left or/and the right hepatic duct 8.3%, and the unclassified location 60.4%. These characteristics included a membranous/septum appearance (44.7%) and a circumferential/relative stenosis (22.7%). The laparoscopic techniques were the wide hilar Roux-en-Y hepaticojejunostomy (28.5%), the excision of membranes/septum (26.5%), and the mixed hepatic ductoplasty (45.0%). The outcomes revealed a minor bile leakage of 3.8% and minimal bleeding. The meta-analysis showed no statistical difference between laparoscopic and open techniques in hepatolithiasis (0% versus 2.00%), anastomosis stricture (4.83% versus 10.00%), and no recurrent cholangitis. There was no conversion rate but showed a trend the prolonged operating time in laparoscopy. Laparoscopic hepatic ductoplasty is safe and effective. The characteristics and location can be feasible laparoscopic procedures. So, hepatic ductoplasty decreases hepatolithiasis, anastomosis stricture, or recurrent cholangitis and may increase minor bile leakage. The systematic review registration was PROSPERO system with CRD42022332145.
