Laparoscopic management of pediatric choledochal cysts in developing countries: review of ten cases

Byline: K. R. Srimurthy (1,2), S. Ramesh (1) Keywords: Laparoscopy; Choledochal cyst (CDC); Minimally invasive surgery (MIS); Laparoscopic surgery Abstract: We report laparoscopic management of choledochal cysts (CDC) in 10 children. We dissect the CDC using conventional mono- and bi-polar diathermy up to the lower end, ligate or clip it at the lowest possible level and divide it. The proximal end is divided after leaving a sufficient cuff for anastomosis. In the first three cases, we formally opened to complete the biliary-enteric anastomosis. However, in the subsequent seven cases, we made a small midline incision to develop a Roux-en Y loop, and the anastomosis was then completed by intra-corporeal suturing after re-creating the pneumo-peritoneum. Apart from biliary leak in one case, we did not encounter any major complications. The mean operative time was 4.2 h. We have discussed the technical points in the study. We conclude that CDC is eminently suitable for laparoscopic correction it requires advanced skills and expertise for precise dissection and meticulous suturing in restricted spaces. If the case selection is good and if the team is experienced, CDC can be effectively managed using laparoscopy even without a sophisticated equipment. The wound- and scar-related morbidity is minimized. Author Affiliation: (1) Indira Gandhi Institute of Child Health , South Hospital Complex, 560 029, Bangalore, India (2) Bangalore Hospital, 202, R.V.Road, 560 029, Bangalore, India Article History: Registration Date: 04/11/2005 Accepted Date: 07/09/2005 Online Date: 07/12/2005