Causes and treatment of reoperation after laparoscopic cyst excision of choledochal cyst

Objective\r\nTo explore the causes of reoperation for laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy for choledochal cyst in children and the choice of surgical procedure.\r\n\r\n\r\nMethods\r\nRetrospective analyses were performed for 245 cases of laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy choledochal cyst from March 2012 to October 2016.There were 42 males and 203 females.And the clinical types were cystic (n=209) and fusiform (n=36).\r\n\r\n\r\nResults\r\nLaparoscopic procedure was completed successfully for 243 cases. Two cases were converted into open laparotomy due to portal venous hemorrhage and air embolism. Reoperation was performed for hemorrhage (n=1), bile leakage (n=2), anastomotic stenosis (n=4) and gallbladder fossa or subphrenic encapsulated fluid (n=2). And exploratory laparotomy was performed for 1 hemorrhagic case. Intraoperative hemorrhage occurred from cyst surface. One case of bile leakage was cured completely after puncture drainage for encapsulated fluid while another get laparotomy for rehepatoenterostomy due to diffuse peritonitis. Laparoscopic rehepatoenterostomy for anastomotic stenosis were performed for 4 cases. Of which 1 case was performed 2 weeks after surgery due to obstructive jaundice. 3 cases were found with abnormal liver function; GPT and r-GT continued increasing or MRCP showed hepatic duct signal interruption. Among them, 2 cases had obstructive jaundice while another case without obstructive jaundice. Abdominal puncture drainage was performed for two encapsulated fluid cases including gallbladder fossa encapsulated fluid (n=1) and subphrenic encapsulated fluid (n=1). Drainage tube was removed after 4 days. All 9 cases were cured after reoperation.\r\n\r\n\r\nConclusions\r\nLaparoscopic total cyst excision with Roux-en-Y hepatoenterostomy for choledochal cyst is a complex and high-risk procedure so that re-operation requires timely operator judgments and appropriate treatments. Laparoscopic rehepatoenterostomy is feasible.\r\n\r\n\r\nKey words: \r\nCholedochal cyst; Laparoscopy; Reoperation; Postoperative complications