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1.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563695

RESUMO

Choledochal cyst and gallbladder duplication are rare congenital anomalies. They typically are surgical problems of infancy or childhood but rarely may present in adults also. Despite high resolution imaging, the differentiation of type II choledochal cyst from gallbladder duplication often causes the diagnostic dilemma; which may result in high risk for intraoperative iatrogenic injury. Operative management of choledochal cyst is the definite treatment because of its malignant potential. A type II choledochal cyst arising from the hepatic hilum presenting as gallbladder duplication on imaging has not been reported earlier in the literature and here we present a case report of the same which was managed successfully.


Assuntos
Cisto do Colédoco/diagnóstico por imagem , Cisto do Colédoco/cirurgia , Adulto , Biomarcadores/sangue , Colangiopancreatografia por Ressonância Magnética , Diagnóstico Diferencial , Feminino , Vesícula Biliar/anormalidades , Humanos , Ultrassonografia
2.
Medicine (Baltimore) ; 100(2): e24022, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466146

RESUMO

RATIONALE: Biliary cysts (BC) are rare dilatations of various parts of a biliary tract. They account for approximately 1% of all benign biliary diseases. Total cyst excision and Roux-Y hepaticojejunostomy is the treatment method of choice in most patients. In this paper, a novel surgical treatment with the use of internal biliary and pancreatic catheters was presented. PATIENT CONCERNS: A 21-years-old woman with a giant choledochal cyst of Todani IA type presenting with abdominal pain, nausea, fever and palpable abdominal mass. It had been previously drained as a misdiagnosed pancreatic cyst in another hospital. DIAGNOSIS: A very high amylase level (107140,0 U/l) in drain fluid was noted in laboratory tests. Endoscopic retrograde cholangiopancreatography revealed a biliary cyst located in the distal common bile duct and a pancreaticobiliary anomaly was suggested. A cholangiography per catheter inserted to the biliary cyst showed a large round contrast-filled cyst. A cholangiography following cyst decompression revealed a very long, tortuous bile duct entering the duodenum. INTERVENTIONS: Cholecystectomy, cyst resection, Roux-Y hepaticojejunostomy, and implantation of catheters into pancreatic and bile duct were performed. The postoperative course was uneventful and she was discharged on 12th day without any complications. Histopathology revealed a cyst wall partially lined with biliary-type and mucinous epithelium, with dysplasia ranging from low to high grade (biliary intraepithelial neoplasia, high grade), without invasion. OUTCOMES: The biliary and pancreatic catheters were removed during endoscopic retrograde cholangiopancreatography 8 weeks following surgery without any complications. Fourteen months later, the patient reported good health. LESSONS: Diagnosis of the abdominal cyst should be very precise in order to avoid misdiagnosis and inadequate management. The early diagnosis and proper treatment of BC are needed in order to avoid serious complications. The cholangiocarcinoma is the most dangerous potential complication of BC due to dysplasia within the cyst wall as in our young female patient.


Assuntos
Cisto do Colédoco/patologia , Cisto do Colédoco/cirurgia , Anastomose em-Y de Roux/métodos , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia/métodos , Ducto Colédoco/patologia , Feminino , Humanos , Adulto Jovem
3.
BMC Surg ; 20(1): 243, 2020 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-33069222

RESUMO

BACKGROUND: To compare the efficacy of total and conventional laparoscopic hepaticojejunostomy (TLH and CLH) in children with choledochal cysts (CDCs). METHODS: Data from patients undergoing TLH and CLH between August 2017 and December 2018 were retrospectively analyzed. Intraoperative blood loss, time for jejunum-cojejunum anastomosis, time to oral intake, postoperative hospital stay, hospitalization expenses, and postoperative complications were compared. RESULTS: All 55 patients (TLH = 30, CLH = 25) were successfully treated without conversion to open surgery. In the TLH and CLH groups, the time to oral intake was 3.57 ± 0.19 d and 4.56 ± 0.27 d, respectively (t = 3.07, P < 0.01), the postoperative hospital stay was 5.50 ± 0.28 d and 7.00 ± 0.74 d (t = 2.03, P < 0.05), and the hospitalization expenses were CNY 40,085 ± 2447 and CNY 26,084 ± 2776 (t = 3.79, P < 0.001). There were no significant differences in intraoperative blood loss (9.57 ± 3.28 ml vs 8.2 ± 1.13 ml, t = 0.37, P = 0.72) or time for jejunum-cojejunum anastomosis (80.5 ± 2.46 min vs 75.00 ± 2.04 min, t = 1.68, P = 0.10). The median follow-up periods of the TLH and CLH groups were 17 and 16 months, respectively. Overall complication rates were comparable between the two groups (10% vs 8%, χ2 = 0.07, P = 0.79). CONCLUSIONS: TLH in children with CDCs has the advantages of rapid gastrointestinal functional recovery and a short hospitalization. However, hospitalization is relatively expensive.


Assuntos
Anastomose em-Y de Roux/métodos , Cisto do Colédoco/cirurgia , Laparoscopia/métodos , Estudos de Casos e Controles , Criança , Feminino , Humanos , Jejunostomia , Tempo de Internação , Masculino , Estudos Retrospectivos , Resultado do Tratamento
4.
PLoS One ; 15(9): e0239857, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986787

RESUMO

OBJECTIVE: The outcomes of children with Choledochal cyst who undergo laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy versus open cyst excision and Roux-en-Y hepaticojejunostomy have not been adequately compared. We conducted a systematic review and meta-analysis to gain further insight into the efficacy and safety of laparoscopic excision in children with choledochal cysts. METHODS: A systematic search of PubMed, Embase, Cochrane Central Register, and ClinicalTrials.gov databases from January 1973 to January 31, 2020 was performed utilizing the PRISMA guidelines. Short-term, long-term and total postoperative complications were the primary endpoint measurements, whereas intraoperative outcomes and other postoperative outcomes were the secondary endpoints. RESULTS: The final analysis included 14 retrospective cohorts comprising 1767 patients. There were no significant differences in the patients' short-term postoperative complications (RR = -1.08; 95% CI = -1.72 to -0.67) between the 2 approaches. However, improvements in long-term (RR = 0.09; 95% CI = 0.01 to 0.18) and total postoperative complications (RR = -0.29; 95% CI = -0.40 to -0.21), estimated intraoperative blood loss and transfusion, time of initial feeding, and length of hospital stay were observed in patients who underwent laparoscopic excision when compared to those who underwent open surgery. CONCLUSIONS: Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy provides similar or even improved intraoperative, postoperative outcomes when compared to open excision for children with Choledochal cyst.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Adolescente , Anastomose em-Y de Roux , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Jejuno/cirurgia , Tempo de Internação , Fígado/cirurgia , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
5.
Mymensingh Med J ; 29(2): 337-340, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32506087

RESUMO

Excision of type I choledochal cyst mandates restoration of continuity of extrahepatic biliary drainage system through anastomotic options having their advantages and disadvantages. Roux en-Y Hepaticojejunostomy (RYHJ) has been very popular and long studied standard surgical treatment for type I choledochal cyst. But now Hepaticoduodenostomy (HD) is also being practiced and studied in different centers all over the world for the treatment of the same disease. We have been practicing Hepaticoduodenostomy for treating type I choledochal cyst, at Bangabandhu Sheik Mujib Medical University (BSMMU), for last five years. Here, we are presenting our experience at BSMMU Hospital, regarding immediate post-operative outcome of Hepaticoduodenostomy for the treatment of type I Choledochal cyst, to show whether this procedure can be safely practiced, producing acceptable results. It is a retrospective document review of forty two MRCP confirmed type I Choledochal cyst children, admitted and operated at BSMMU Hospital, from January 2013 to December 2017. Patient's particulars, history, physical examination, investigations (including MRCP confirmation), assessment, surgical plan were collected from relevant medical records under standard privacy protocol. Information regarding early post-operative outcome of Hepaticoduodenostomy in treating uncomplicated type I choledochal cyst were searched for review and evaluation, specifically with respect to- a) mortality (if any); b) morbidities like- i) prolonged post-operative abdominal pain, ii) anastomotic bile leak, iii) features of early Cholangitis, iv) wound dehiscence and c) prolonged Hospital stay. There was no immediate post-operative mortality. But 9(21.42%) patients had prolonged post-operative pain requiring parenteral Pethidine 'on demand' beyond second post-operative day, 2(4.76%) had anastomotic bile leak, 7(16.67%) had early cholangitis and 1(2.38%) had abdominal wound dehiscence; they (21.42%) also stayed in hospital for more than fourteen days. The outcome was acceptably safe when compared with other studies abroad. Through this study, at BSMMU Hospital, immediate post-operative outcome of Hepaticoduodenostomy for treating type I choledochal cyst- in terms of morbidity, mortality and hospital stay- was found to be yielding acceptable results, for safe practice.


Assuntos
Ductos Biliares Extra-Hepáticos , Cisto do Colédoco/cirurgia , Laparoscopia , Anastomose em-Y de Roux , Anastomose Cirúrgica , Criança , Humanos , Estudos Retrospectivos , Resultado do Tratamento
6.
Clinics (Sao Paulo) ; 75: e1539, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32215454

RESUMO

OBJECTIVE: To identify the best mode for diagnosing and treating the patients with choledochal cysts. METHODS: A retrospective study was performed with medical records of patients diagnosed with choledochal cysts from January 1994 to December 2017. In all cases, the diagnosis was based on ultrasound examination. All the patients underwent cyst resection and were divided in two groups: bile enteric anastomosis in the high portion of the common hepatic duct or in the dilated lower portion. RESULTS: Eighty-one cases were studied. The age of presentation was 4 y 2 mo ± 4 y 1 mo, and the age for the surgical treatment was 5 y 5 mo ± 4 y 6 mo. In 61 cases, US was the only image examination performed. There were 67 cases of Todani type I (82.7%), 13 cases of type IV (16.0%) and one case of type III (1.2%). Nine patients (29.0%) in the first period and 2 patients (4.0%) in the second period presented with postoperative complications (p=0.016). CONCLUSION: In patients with choledochal cysts, US is the only necessary diagnostic imaging. Performing the bile enteric anastomosis in the lower portion of the common hepatic duct is safer and has a lower risk of complications.


Assuntos
Ductos Biliares/diagnóstico por imagem , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/diagnóstico , Cisto do Colédoco/cirurgia , Criança , Cisto do Colédoco/classificação , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
7.
Pediatr Surg Int ; 36(5): 643-648, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32219559

RESUMO

OBJECTIVE: To explore the clinical value of enhanced recovery after surgery (ERAS) with laparoscopic choledochal cyst (CDC) excision in children. METHODS: A retrospective review was performed on the clinical data from 33 in-patients whose final diagnosis was CDC. We included 18 patients who underwent the traditional treatment for CDC from April 2017 to October 2017 as the control group and 15 patients who underwent the enhanced recovery protocol (ERP) from November 2017 to May 2018 as the ERAS group. All the patients had received three-dimensional (3D) laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy by the same group of pediatric surgeons. The time of initial water intake, postoperative time to total enteral nutrition (TEN), postoperative hospital stay, total cost in hospital, postoperative complications, and readmission rate within 30 days were analysed. RESULTS: The postoperative time of initial water intake, postoperative time to TEN, postoperative hospital stay, and total cost in hospital were (21.5 ± 2.1) h, (4.3 ± 0.5) days, (5.3 ± 0.6) days, and (35,945.49 ± 6071.46) China Yuan (CNY) in the ERAS group and (44.1 ± 3.5) h, (7.7 ± 2) days, (9.1 ± 2.5) days, and (45,609.08 ± 11,439.80) CNY in the control group, respectively. These values in the ERAS group were significantly lower than those in the control group (p < 0.05). There was no significant difference between the two groups in terms of postoperative complications. No readmission patient within 30 days was encountered in either of the two groups. CONCLUSION: Enhanced recovery protocols can shorten postoperative hospital stay, relieve perioperative discomfort, lighten the financial burden, and result in substantial improvements.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Ducto Colédoco/cirurgia , Recuperação Pós-Cirúrgica Melhorada , Imageamento Tridimensional/métodos , Laparoscopia/métodos , Anastomose Cirúrgica , Cisto do Colédoco/diagnóstico , Ducto Colédoco/diagnóstico por imagem , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Readmissão do Paciente , Complicações Pós-Operatórias , Estudos Retrospectivos
8.
Am J Clin Pathol ; 153(6): 760-771, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32010932

RESUMO

OBJECTIVES: Histopathologic characteristics of choledochal cysts and their clinical implications have not been previously comprehensively studied. METHODS: Smooth muscle distribution patterns and other histologic findings (inflammation, metaplasia, dysplasia, and heterotopia) in 233 surgically resected choledochal cysts were evaluated. RESULTS: Mean patient age was 23.3 ±â€…19.8 years, with male:female ratio of 0.3. Most cases were Todani type I (175 cases, 75.1%) or IVa (56 cases, 24.1%). Choledochal cysts with thin scattered/no muscle fiber (175 cases, 75.1%) were the predominant pattern and were associated with more frequent postoperative biliary stricture (P = .031), less frequent pyloric metaplasia (P = .016), and mucosal smooth muscle aggregates (P < .001) compared to cysts with thick muscle bundles. Severe chronic cholangitis (P = .049), pyloric metaplasia (P = .019), mucosal smooth muscle aggregates (P < .001), biliary intraepithelial neoplasia (P = .021), and associated bile duct (P = .021) and gallbladder carcinomas (P = .03) were more common in adults (age >20 years vs ≤20 years), suggesting that chronic irritation in association with developmental anomalies involves tumorigenesis from choledochal cysts. CONCLUSION: Smooth muscle distribution pattern of choledochal cyst may predict postoperative complication, raising clinical implications of smooth muscle patterns in postoperative management of choledochal cysts.


Assuntos
Cisto do Colédoco/patologia , Músculo Liso/patologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Cisto do Colédoco/cirurgia , Feminino , Humanos , Hiperplasia/patologia , Lactente , Recém-Nascido , Inflamação/patologia , Masculino , Metaplasia/patologia , Pessoa de Meia-Idade , Adulto Jovem
9.
J Laparoendosc Adv Surg Tech A ; 30(3): 344-349, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31928494

RESUMO

Background: This study aimed to explore the clinical efficacy of three-dimensional (3D) laparoscopic surgery in the treatment of congenital choledochal cysts (CCCs) by comparing it with two-dimensional (2D) laparoscopic surgery. Patients and Methods: We retrospectively reviewed data of 155 pediatric patients who underwent surgical treatment of choledochal cysts between January 2014 and December 2017. We divided the patients into two groups according to the surgical method used-a 3D laparoscopic group (N = 42) and a 2D laparoscopic group (N = 113). The 3D laparoscopic group was further divided into two subgroups based on age-Group 1 (age ≤12 months, N = 11) and Group 2 (age >12 months, N = 31). We analyzed data in terms of the following characteristics: patient demographics, perioperative and follow-up conditions, and complications. Moreover, we also recorded and analyzed the surgeon's assessment on laparoscopic system usage. Results: Cyst excision and Roux-en-Y hepaticojejunostomy (HJ) was successfully completed in all the patients. Intergroup differences in operating time and blood loss were statistically significant. There were no significant differences between the two groups in early and late complications, such as the incidence of wound infection, HJ stricture, or adhesive ileus. There were no significant differences in the operative data and outcomes between the two subgroups of patients who underwent 3D laparoscopic treatment. Based on surgeon's assessment, the 3D laparoscopic system had better depth perception and accuracy than the 2D laparoscopic system; however, there was no difference in the adverse effect on surgeons. Conclusions: Compared with the traditional 2D laparoscopic surgery, 3D laparoscopic surgical resection of CCCs combined with jejunum Roux-en-Y anastomosis is a safer and more effective procedure that can shorten operative time and reduce intraoperative bleeding with no increase in surgical strain. The 3D laparoscopic surgery technique may provide a better choice for CCC operations.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Jejuno/cirurgia , Laparoscopia/métodos , Fígado/cirurgia , Anastomose em-Y de Roux/métodos , Anastomose Cirúrgica , Pré-Escolar , Constrição Patológica , Percepção de Profundidade , Feminino , Humanos , Lactente , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Cirurgiões , Resultado do Tratamento
11.
Pan Afr Med J ; 37: 95, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33425128

RESUMO

Choledochal cysts are rare congenital anomalies of the biliary tract. There are 5 subtypes of choledochal cyst and in adults type 4 is the most common. Choledochal cyst rarely exceeds the size of 6cm in the reported literature. Only a handful of cases of giant choledochal cysts are reported in the literature. Here we report a case of a 33-year-old lady who presented with a huge abdominal mass and on evaluation was found to have a giant choledochal cyst type 4A. The patient underwent excision of the extrahepatic hugely dilated choledochal cyst with cholecystectomy and reconstruction was done by Roux-en-Y hepaticojejunostomy to the confluence of the right and left hepatic duct at the hilum.


Assuntos
Anastomose em-Y de Roux/métodos , Colecistectomia/métodos , Cisto do Colédoco/cirurgia , Adulto , Cisto do Colédoco/diagnóstico , Feminino , Ducto Hepático Comum/cirurgia , Humanos , Jejunostomia/métodos
12.
BJS Open ; 3(6): 785-792, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31832585

RESUMO

Background: Todani type 1 and 4 choledochal cysts are associated with a risk of developing cholangiocarcinoma. Resection is usually recommended, but data for asymptomatic Western adults are sparse. The aim of this study was to investigate diagnostic interpretation and attitudes towards resection of bile ducts for choledochal cysts in this subgroup of patients across northern European centres. Methods: Thirty hepatopancreatobiliary centres were provided with magnetic resonance cholangiopancreatograms and asked to discuss the management of six cases: asymptomatic non-Asian women, aged 30 or 60 years, with variable common bile duct (CBD) dilatations and different risk factors in the setting of a multidisciplinary team (MDT). The Fleiss κ value was calculated to estimate overall inter-rater agreement. Results: For all case scenarios combined, 83·3 and 86·7 per cent recommended resection for a CBD of 20 and 26 mm respectively, compared with 19·4 per cent for a CBD of 13 mm (P < 0·001). For patients aged 30 and 60 years, resection was recommended in 68·5 and 57·8 per cent respectively (P = 0·010). There was a trend towards recommending resection in the presence of a common channel, most pronounced in the 60-year-old patient. High amylase levels in the CBD aspirate led to recommendations to resect, but only for the 13-mm CBD dilatation. There were no differences related to centre size or region. MDT discussion was associated with recommendations to resect. Inter-rater agreement was 73·3 per cent (κ = 0·43, 95 per cent c.i. 0·38 to 0·48). Conclusion: The inter-rater agreement to resect was intermediate, and the recommendation was dependent mainly on the diameter of the CBD dilatation.


Assuntos
Colecistectomia/estatística & dados numéricos , Cisto do Colédoco/cirurgia , Tomada de Decisão Clínica , Ducto Colédoco/diagnóstico por imagem , Cirurgiões/psicologia , Adulto , Fatores Etários , Doenças Assintomáticas/terapia , Neoplasias dos Ductos Biliares/etiologia , Neoplasias dos Ductos Biliares/prevenção & controle , Colangiocarcinoma/etiologia , Colangiocarcinoma/prevenção & controle , Colangiopancreatografia por Ressonância Magnética , Colecistectomia/psicologia , Cisto do Colédoco/complicações , Cisto do Colédoco/diagnóstico , Ducto Colédoco/anormalidades , Ducto Colédoco/cirurgia , Europa (Continente) , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
13.
Rev Esp Enferm Dig ; 111(12): 977, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31793326

RESUMO

We read with great interest the scientific letter by Sánchez Melgarejo JF et al., in which they report a degenerate Todani Ia choledochal cyst in a patient with a pancreas divisum. However, patients with a choledochal cyst might benefit from per oral cholangioscopy for malignancy detection and extension evaluation.


Assuntos
Cisto do Colédoco/cirurgia , Laparoscopia , Humanos , Pâncreas
17.
Pediatr Surg Int ; 35(12): 1421-1425, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31555861

RESUMO

AIM: We compared robotic hepaticojejunostomy anastomosis (RHJA) with laparoscopic hepaticojejunostomy anastomosis (LHJA) in children undergoing complete excision of choledochal cyst. METHODS: Difficulty of suturing (DOS) during anastomosis was scored blindly, from intraoperative video recordings, using: 5 = impossible; 4 = difficult; 3 = tedious; 2 = slow; and 1 = easy. A panel of fiveindependent surgeons was also asked to compare RHJA with matched LHJA and score + 1 if RHJA appeared superior to LHJA, 0 if RHJA appeared equivalent to LHJA, and - 1 if RHJA appeared inferior to LHJA. RESULTS: RHJA (n = 10) was performed between 2017 and 2019; LHJA (n = 27) was performed between 2009 and 2018. LHJA cases were matched for age, weight, and anastomosis diameter to RHJA cases. Complete excision was performed laparoscopically in both groups. DOS was lower in RHJA with less variance. The panel all scored RHJA as + 1. Total anastomotic time (TAT) and TAT per suture were significantly shorter for RHJA. Times taken to ambulate and for return of bowel sounds postoperatively were significantly shorter for RHJA. There was one anastomotic leak with LHJA (3.7%) and no anastomotic complications with RHJA. CONCLUSIONS: RHJA is a more stable anastomosis that can be performed quicker, and thus, would appear to be superior to LHJA.


Assuntos
Cisto do Colédoco/cirurgia , Hepatectomia/métodos , Jejunostomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Resultado do Tratamento
18.
J Laparoendosc Adv Surg Tech A ; 29(10): 1345-1348, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31532300

RESUMO

Aim: In children, the diameter at the hepaticojejunostomy anastomosis (HJA) can range from 10 mm to less than 5 mm, irrespective of the type of choledochal cyst (CC). We developed a maneuver that involves everting the mucosa (EM) of the Roux-en-Y loop jejunum and the common hepatic duct mucosa circumferentially, to facilitate suturing during laparoscopic HJA (lap-HJA). Otherwise, it is extremely difficult to distinguish between the lumen and the mucosa on the jejunal side. Methods: We used EM to treat 18 consecutive children with CC between 2016 and 2018. After transumbilical, extracorporeal Roux-en-Y loop-plasty, the closed end of the jejunum was incised with a scalpel and bleeding points were coagulated with bipolar diathermy. During lap-HJA, the mucosa at the incision was everted circumferentially by using 7/0 absorbable sutures and anastomosed securely to the common hepatic duct by using 5/0 or 6/0 absorbable sutures. Results: Mean age at surgery was 4.0 years old. HJA diameters were <5 mm (n = 4), 5-9 mm (n = 11), and >9 mm (n = 3). In all cases, EM allowed the lumen at the incision in the Roux-en-Y loop jejunum to be distinguished readily, and suturing proceeded smoothly. After follow-up of a mean of 1.5 years (range 0.5-3.0), no anastomotic leakages or stenoses have been reported. Conclusions: EM greatly facilitated secure anastomosis during lap-HJA, even when the diameter at the anastomosis was <5 mm. The safety and efficiency of lap-HJA in children with CC could be improved by this simple maneuver.


Assuntos
Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Mucosa Intestinal/cirurgia , Jejunostomia/métodos , Laparoscopia/métodos , Adolescente , Anastomose em-Y de Roux , Fístula Anastomótica/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Técnicas de Sutura
19.
J Laparoendosc Adv Surg Tech A ; 29(10): 1378-1382, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31539299

RESUMO

Purpose: Various studies have shown the benefit of three-dimensional (3D) systems over two-dimensional (2D) systems in endoscopic surgery. However, few studies have focused on pediatric endosurgery. The purpose of this study was to assess the impact of 2D and 3D environments on the time taken and forceps manipulation by comparing experts and trainees using a laparoscopic hepaticojejunostomy simulator. Methods: We have developed a simulator of laparoscopic hepaticojejunostomy for congenital biliary dilatation. Seventeen participants of pediatric surgeons (4 experts and 13 trainees) performed hepaticojejunostomy using our simulator in both 2D and 3D environment. We evaluated the required time, total path length, and average velocities of bilateral forceps in both situations. Results: Obtained results show the findings for the required time (seconds; 2D, experts: 810.43 ± 321.64 vs. trainees: 1136.02 ± 409.96, P = .17) (seconds; 3D, experts: 660.21 ± 256.48 vs. trainees: 1017 ± 280.93, P = .039), total path length of right forceps (mm; 2D, experts: 38838.23 ± 30686.63 vs. trainees: 52005.47 ± 31675.02, P = .48)(mm; 3D, experts: 24443.09 ± 12316.32 vs. trainees: 45508.09 ± 26926.27, P = .16), total path length of left forceps (mm; 2D, experts: 131635.54 ± 71669.94 vs. trainees: 245242.48 ± 130940.25, P = .48)(mm; 3D, experts: 88520.42 ± 56766.63 vs. trainees: 230789.75 ± 107315.85, P = .024), average velocities of right forceps (mm/second; 2D, experts: 44.80 ± 21.85 vs. trainees: 44.37 ± 18.92, P = .97) (mm/second; 3D, experts: 37.28 ± 16.49 vs. trainees: 42.58 ± 14.40, P = .54), average velocities of left forceps (mm/second; 2D, experts: 156.65 ± 38.69 vs. trainees: 202.58 ± 63.80, P = .20) (mm/second; 3D, experts: 125.64 ± 44.30 vs. trainees: 219.42 ± 43.82, P < .01). Conclusion: The experts performed more effectively when using the 3D system. Using 3D, the total path length of the left forceps of expert pediatric surgeons was significantly shorter than trainee pediatric surgeons, and the average velocities of the left forceps tip of expert pediatric surgeons was significantly slower than trainee pediatric surgeons. These results suggest that training of assisting hand is necessary for advanced pediatric endosurgery to avoid organ injury.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Ducto Hepático Comum/cirurgia , Jejunostomia/métodos , Laparoscopia/métodos , Pediatria , Treinamento por Simulação/métodos , Procedimentos Cirúrgicos do Sistema Biliar/educação , Competência Clínica , Humanos , Imageamento Tridimensional , Jejunostomia/educação , Jejuno/cirurgia , Laparoscopia/educação , Pediatria/educação , Pediatria/métodos , Instrumentos Cirúrgicos
20.
World J Gastroenterol ; 25(26): 3334-3343, 2019 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-31341359

RESUMO

Choledochal cysts (CCs) are rare bile duct dilatations, intra-and/or extrahepatic, and have higher prevalence in the Asian population compared to Western populations. Most of the current literature on CC disease originates from Asia where these entities are most prevalent. They are thought to arise from an anomalous pancreaticobiliary junction, which are congenital anomalies between pancreatic and bile ducts. Some similarities in presentation between Eastern and Western patients exist such as female predominance, however, contemporary studies suggest that Asian patients may be more symptomatic on presentation. Even though CC disease presents with an increased malignant risk reported to be more than 10% after the second decade of life in Asian patients, this risk may be overstated in Western populations. Despite this difference in cancer risk, management guidelines for all patients with CC are based predominantly on observations reported from Asia where it is recommended that all CCs should be excised out of concern for the presence or development of biliary tract cancer.


Assuntos
Neoplasias do Sistema Biliar/prevenção & controle , Colangiopancreatografia Retrógrada Endoscópica/normas , Cisto do Colédoco/epidemiologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Neoplasias do Sistema Biliar/patologia , Cisto do Colédoco/patologia , Cisto do Colédoco/cirurgia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Gastroenterologia/normas , Humanos , Masculino , Guias de Prática Clínica como Assunto , Prevalência , Fatores Sexuais , Resultado do Tratamento
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