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Wei Cheng - One of the best experts on this subject based on the ideXlab platform.
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role of laparoscopy in treatment of Choledochal Cysts in children
Pediatric Surgery International, 2013Co-Authors: Mei Diao, Wei ChengAbstract:Laparoscopy enables surgeons to approach the surgical conditions from a new perspective. Laparoscopic surgery has revolutionized the treatment of Choledochal Cysts (CDC). Yet, this new technique requires objective evaluations. We have examined the controversies about the CDC dissection, distal common bile duct ligation, ductoplasty for hepatic duct stenosis, intrahepatic duct and common channel protein plug clearance, timing of surgery for antenatally diagnosed CDC, and the Roux loop length in CDC children. In the hands of experts, laparoscopic excision of the cyst and Roux-en-Y hepaticojejunostomy is a safe and effective approach. We provide our opinions on these issues based on our experience and publications. We conclude that the main outcomes comparable to those of the open surgery. The better wound cosmesis and reduction of surgical trauma are the advantages.
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single incision laparoscopic roux en y hepaticojejunostomy using conventional instruments for children with Choledochal Cysts
Surgical Endoscopy and Other Interventional Techniques, 2012Co-Authors: Mei Diao, Ning Dong, Wei ChengAbstract:Background Single-incision laparoscopy has recently become popular in pediatric surgery. Yet there has been no report on its application in the management of Choledochal Cysts (CDC). The current series is the first study to evaluate the safety and efficacy of single-incision laparoscopic hepaticojejunostomy (SILH) for CDC in children.
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laparoscopic versus open roux en y hepatojejunostomy for children with Choledochal Cysts intermediate term follow up results
Surgical Endoscopy and Other Interventional Techniques, 2011Co-Authors: Mei Diao, Long Li, Wei ChengAbstract:Background Laparoscopic hepatojejunostomy (LH) for children with Choledochal Cysts (CDC) has been gaining popularity recently. However, its safety and efficacy remain unknown. The purpose of this study was to evaluate the intermediate-term results of LH for CDC children.
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is it necessary to ligate distal common bile duct stumps after excising Choledochal Cysts
Pediatric Surgery International, 2011Co-Authors: Mei Diao, Long Li, Wei ChengAbstract:Purpose After excision of Choledochal Cysts (CDC), the distal common bile duct (CBD) stumps are conventionally ligated. Yet, the distal common bile duct stump mobilization and ligation carries certain risk of pancreatic duct injury. The current study investigates the feasibility of selectively leaving distal stump unligated in CDC children with stenotic distal CBD.
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Laparoscopic-assisted clearance of protein plugs in the common channel in children with Choledochal Cysts
Journal of Pediatric Surgery, 2010Co-Authors: Mei Diao, Jin-shan Zhang, Long Li, Wei ChengAbstract:Abstract Background The purpose of the study was to assess the efficacy of laparoscopic-assisted removal of protein plugs from the common channel in Choledochal Cysts. Methods Between 2001 and 2009, 34 patients with Choledochal Cysts (mean age, 4.98 years) with protein plugs in the common channel successfully underwent laparoscopic cyst excision and Roux-en-Y hepatojejunostomy. Under direct vision during laparoscopy, urethroscopes or catheters were inserted into the common channel to irrigate and remove the protein plugs. Complete clearance was confirmed by either direct urethroscopic visualization or cholangiogram that demonstrated (1) no filling defects in the common channel, (2) significant reduction of common channel diameter, (3) free passage of contrast agent into the duodenum, and (4) no pancreatic duct reflux. Operative time and blood loss, postoperative hospital stay, duration of drainage, postoperative complications, perioperative ultrasonographic findings, and laboratory results were reviewed. Results Protein plugs were completely removed in all the patients. The mean operative time, postoperative hospital stay, and drainage duration were 3.51 hours, 7.08 days, and 3.41 days, respectively. The median follow-up period was 32 months. Neither mortality nor complications of pancreatic juice leak, pancreatitis, or stone formation were observed. Liver function parameters and serum amylase levels returned to normal postoperatively. Conclusions Laparoscopic-assisted clearance of the protein plugs in the common channel in Choledochal cyst is effective, with good medium-term results observed.
Mei Diao - One of the best experts on this subject based on the ideXlab platform.
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role of laparoscopy in treatment of Choledochal Cysts in children
Pediatric Surgery International, 2013Co-Authors: Mei Diao, Wei ChengAbstract:Laparoscopy enables surgeons to approach the surgical conditions from a new perspective. Laparoscopic surgery has revolutionized the treatment of Choledochal Cysts (CDC). Yet, this new technique requires objective evaluations. We have examined the controversies about the CDC dissection, distal common bile duct ligation, ductoplasty for hepatic duct stenosis, intrahepatic duct and common channel protein plug clearance, timing of surgery for antenatally diagnosed CDC, and the Roux loop length in CDC children. In the hands of experts, laparoscopic excision of the cyst and Roux-en-Y hepaticojejunostomy is a safe and effective approach. We provide our opinions on these issues based on our experience and publications. We conclude that the main outcomes comparable to those of the open surgery. The better wound cosmesis and reduction of surgical trauma are the advantages.
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single incision laparoscopic roux en y hepaticojejunostomy using conventional instruments for children with Choledochal Cysts
Surgical Endoscopy and Other Interventional Techniques, 2012Co-Authors: Mei Diao, Ning Dong, Wei ChengAbstract:Background Single-incision laparoscopy has recently become popular in pediatric surgery. Yet there has been no report on its application in the management of Choledochal Cysts (CDC). The current series is the first study to evaluate the safety and efficacy of single-incision laparoscopic hepaticojejunostomy (SILH) for CDC in children.
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laparoscopic versus open roux en y hepatojejunostomy for children with Choledochal Cysts intermediate term follow up results
Surgical Endoscopy and Other Interventional Techniques, 2011Co-Authors: Mei Diao, Long Li, Wei ChengAbstract:Background Laparoscopic hepatojejunostomy (LH) for children with Choledochal Cysts (CDC) has been gaining popularity recently. However, its safety and efficacy remain unknown. The purpose of this study was to evaluate the intermediate-term results of LH for CDC children.
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is it necessary to ligate distal common bile duct stumps after excising Choledochal Cysts
Pediatric Surgery International, 2011Co-Authors: Mei Diao, Long Li, Wei ChengAbstract:Purpose After excision of Choledochal Cysts (CDC), the distal common bile duct (CBD) stumps are conventionally ligated. Yet, the distal common bile duct stump mobilization and ligation carries certain risk of pancreatic duct injury. The current study investigates the feasibility of selectively leaving distal stump unligated in CDC children with stenotic distal CBD.
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Laparoscopic-assisted clearance of protein plugs in the common channel in children with Choledochal Cysts
Journal of Pediatric Surgery, 2010Co-Authors: Mei Diao, Jin-shan Zhang, Long Li, Wei ChengAbstract:Abstract Background The purpose of the study was to assess the efficacy of laparoscopic-assisted removal of protein plugs from the common channel in Choledochal Cysts. Methods Between 2001 and 2009, 34 patients with Choledochal Cysts (mean age, 4.98 years) with protein plugs in the common channel successfully underwent laparoscopic cyst excision and Roux-en-Y hepatojejunostomy. Under direct vision during laparoscopy, urethroscopes or catheters were inserted into the common channel to irrigate and remove the protein plugs. Complete clearance was confirmed by either direct urethroscopic visualization or cholangiogram that demonstrated (1) no filling defects in the common channel, (2) significant reduction of common channel diameter, (3) free passage of contrast agent into the duodenum, and (4) no pancreatic duct reflux. Operative time and blood loss, postoperative hospital stay, duration of drainage, postoperative complications, perioperative ultrasonographic findings, and laboratory results were reviewed. Results Protein plugs were completely removed in all the patients. The mean operative time, postoperative hospital stay, and drainage duration were 3.51 hours, 7.08 days, and 3.41 days, respectively. The median follow-up period was 32 months. Neither mortality nor complications of pancreatic juice leak, pancreatitis, or stone formation were observed. Liver function parameters and serum amylase levels returned to normal postoperatively. Conclusions Laparoscopic-assisted clearance of the protein plugs in the common channel in Choledochal cyst is effective, with good medium-term results observed.
Hisami Ando - One of the best experts on this subject based on the ideXlab platform.
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endoscopic biliary drainage for children with persistent or exacerbated symptoms of Choledochal Cysts
Journal of Hepato-biliary-pancreatic Sciences, 2013Co-Authors: Hironori Tsuchiya, Kenitiro Kaneko, Akihiro Itoh, Hiroki Kawashima, Yasuyuki Ono, Takahisa Tainaka, Naruhiko Murase, Hisami AndoAbstract:Background Symptoms of Choledochal Cysts sometimes persist or become exacerbated. As preoperative management for patients with these Cysts, we prospectively employed endoscopic drainage, based on the theory that protein plugs cause symptoms by obstructing the pancreatobiliary ducts.
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Endoscopic biliary drainage for children with persistent or exacerbated symptoms of Choledochal Cysts
Journal of Hepato-Biliary-Pancreatic Sciences, 2013Co-Authors: Hironori Tsuchiya, Kenitiro Kaneko, Akihiro Itoh, Hiroki Kawashima, Yasuyuki Ono, Takahisa Tainaka, Naruhiko Murase, Hisami AndoAbstract:Background Symptoms of Choledochal Cysts sometimes persist or become exacerbated. As preoperative management for patients with these Cysts, we prospectively employed endoscopic drainage, based on the theory that protein plugs cause symptoms by obstructing the pancreatobiliary ducts. Methods Children with Choledochal Cysts underwent endoscopic retrograde cholangiopancreatography (ERCP). When ERCP showed compaction with filling defects in patients with persistent or worsening symptoms (study patients), the placement of a short biliary stent tube was attempted for drainage. The clinical and ERCP findings of the study patients were compared with those of patients who were asymptomatic at ERCP (asymptomatic patients). Results There were 13 study patients (median age 2.9 years) and 41 asymptomatic patients (4.7 years) enrolled in the study between August 2005 and February 2011. Study patients more frequently had jaundice and elevated transaminase levels. ERCP showed that all study patients had obstruction or compacted filling defects in the common channel or the narrow segment distal to the cyst. Insertion of a stent tube was successful in 11 patients. Symptoms were relieved soon after biliary drainage. Surgery revealed that the obstructing materials were protein plugs, except in one case, which involved fatty acid calcium stones. Conclusions These results support the protein plug theory. Endoscopic short-tube stenting is adequate and effective as preoperative management.
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bile infection contributes to intrahepatic calculi formation after excision of Choledochal Cysts
Pediatric Surgery International, 2005Co-Authors: Kenitiro Kaneko, Hisami Ando, Takahiko Seo, Yasuyuki Ono, Keiko Ochiai, Yukio OguraAbstract:Intrahepatic calculi complicate Choledochal Cysts in 7–8% of patients. Although congenital stenoses and dilatation of the intrahepatic bile ducts are considered responsible for calculi formation, intrahepatic calculi are usually formed after cyst excision. In this study, bile specimens from patients with Choledochal Cysts were cultured for bacteria. Results were retrospectively analyzed among the following groups: the primary excision group, consisting of 97 patients undergoing cyst excision as a primary treatment (mean age 5.0 years), the internal drainage group, consisting of 13 patients who had previous cyst-enterostomy at cyst excision (mean age 20.2 years); and the hepatolithiasis group, consisting of 12 patients with postoperative hepatolithiasis (mean age 24.2 years). Bacteria were present in the bile of 10 patients (76.9%) in the internal drainage group and in all patients (100%) in the hepatolithiasis group, but present in only 17 patients (17.5%) in the primary excision group (p<0.01). Polymicrobial infection with Gram-negative enterobacteria such as Escherichia coli and Klebsiella species was predominant in the internal drainage and hepatolithiasis groups, while nonenteric bacteria were found in the primary excision group. Bile infection through bilioenterostomy may play an important role in intrahepatic calculus formation after excision of a Choledochal cyst.
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Operative treatment of congenital stenoses of the intrahepatic bile ducts in patients with Choledochal Cysts.
American journal of surgery, 1997Co-Authors: Hisami Ando, Kenitiro Kaneko, Fujio Ito, Takahiko Seo, Takahiro ItoAbstract:Background Postoperative complications including intrahepatic calculi may develop after the complete excision of a Choledochal cyst. Since congenital stenoses of the intrahepatic bile ducts are more likely the cause of intrahepatic calculi, operative procedures for intrahepatic stenoses are reported. Methods There were 16 patients with Choledochal Cysts who underwent surgery for stenoses of intrahepatic bile ducts. The stenoses were excised at the opening of the common hepatic duct. Results In the 16 patients, 25 of the 26 stenoses that involved an intraluminal membrane or septum could be excised from the divided end of the common hepatic duct at the hepatic hilum. In 1 patient, the stenosis could not be accessed from the hepatic hilum, and a left hepatic lobectomy was required. In postoperative follow-up, all 16 patients were in good health. Conclusions Stenoses of the intrahepatic bile ducts should be treated from the divided end of the common hepatic duct at the initial operation for Choledochal Cysts. The need for a second operation or hepatic lobectomy may thus be avoided.
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complete excision of the intrapancreatic portion of Choledochal Cysts
Journal of The American College of Surgeons, 1996Co-Authors: Hisami Ando, Kenitiro Kaneko, T Ito, Y Watanabe, T Seo, T Harada, F Ito, M Nagaya, T SugitoAbstract:Background Cyst excision is the treatment for patients with Choledochal Cysts. In general, many authors recommend intramural dissection between the outer and inner layers of the cyst or partial excision leaving part of the cyst in the pancreas to avoid pancreatic injury. However, because there are few large series with long-term follow-up periods, it remains unclear how much of the intrapancreatic portion of the cyst should be resected and what resection technique should be used. Study design During an 18-year period, 104 patients underwent excision of Choledochal Cysts at our hospitals. Twelve patients had partial excision of the cyst above the pancreas, and 17 had intramural dissection of the intrapancreatic portion. Seventy-five patients underwent complete excision of the intrapancreatic portion of the cyst by our new technique, in which the outer plane of the epiCholedochal plexus is dissected, exposing the narrow distal segment connecting the cyst to the pancreatic duct. Our new technique was compared retrospectively with the other two techniques. Results With our technique, the intrapancreatic cyst could be excised completely in 75 patients without any complications. Blood loss was significantly decreased when our technique was used compared to intramural excision. A pancreatic fistula occurred after intramural excision in one patient, and pancreatic stones formed several years after partial excision and intramural excision in three patients who proved to have residual cystic material in the pancreas. Conclusions Our operative technique is safe and effective for the complete excision of the intrapancreatic portion of a Choledochal cyst.
Nguyen Thanh Liem - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic surgery for Choledochal Cysts
Journal of hepato-biliary-pancreatic sciences, 2013Co-Authors: Nguyen Thanh LiemAbstract:Laparoscopic cystectomy has become a common procedure for Choledochal Cysts. The cyst should be removed completely just above the confluence of the common biliopancreatic channel at the distal end and approximately 5 mm from the confluence of the right and left hepatic ducts at the proximal end to avoid complications of the cystic remnant. The operation is feasible and safe. The rate of conversion to open surgery is low. The rate of complication under skill laparoscopic surgeons is also low, even lower than in open surgery. There was no difference between hepaticoduodenostomy and hepaticojejunostomy concerning the rate of cholangitis. Gastritis due to bilious reflux occurred with a low rate in hepaticoduodenostomy. Both techniques could be used for Choledochal Cysts; however, hepaticoduodenostomy should be applied for Choledochal Cysts without intrahepatic dilatation of biliary tract.
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early and intermediate outcomes of laparoscopic surgery for Choledochal Cysts with 400 patients
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2012Co-Authors: Nguyen Thanh Liem, Hien Duy Pham, Le Anh Dung, Tran Ngoc SonAbstract:Abstract Objective: The aim of this study is to report early and intermediate outcomes of laparoscopic surgery for Choledochal Cysts with 400 cases. Patients and Methods: The operation was performed using four ports. The cystic duct was identified and divided. The liver was suspended by two stay-sutures: one on the round ligament and the other on the distal cystic duct. The Choledochal cyst was isolated and removed completely, and biliary–digestive continuity was reestablished by hepaticoduodenostomy (HD) or hepaticojejunostomy (HJ). Results: From January 2007 to June 2011, 400 patients were operated on. There were 305 girls and 95 boys. Ages ranged from 1 month to 16 years (mean, 47.5±2.1 months). Cystic excision and HD were performed in 238 patients and HJ in 162 patients. The mean operating time was 164.8±51 minutes for the HD group and 220±60 minutes for the HJ group. Conversion to open surgery was required in 2 patients. There were no perioperative deaths. Postoperative biliary leakage occurred in 8 ...
F Ito - One of the best experts on this subject based on the ideXlab platform.
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protein plugs cause symptoms in patients with Choledochal Cysts
The American Journal of Gastroenterology, 1997Co-Authors: Kenichiro Kaneko, H Ando, Takaaki Ito, Y Watanabe, T Seo, T Harada, F ItoAbstract:Objectives: Symptoms in patients with Choledochal Cysts are believed to be caused by pancreaticobiliary maljunction. However, this anomaly alone cannot explain the occurrence of symptoms. The aim of this study was to elucidate the etiology of the symptomatology in patients with Choledochal Cysts. Methods: Clinical data and preoperative and operative cholangiopancreatography were reviewed in 55 consecutive patients with Choledochal Cysts seen between 1980 and 1996. Results: The bile duct was significantly larger in the symptomatic phase than in the asymptomatic phase. External biliary drainage resulted in rapid resolution of symptoms in 11 patients. A radiolucent filling defect in the pancreaticobiliary duct was found in 22 patients (40.0%). The defects were in the common channel in 15 patients and near the common channel in 7 patients. Filling defects disappeared spontaneously or after irrigation in 19 patients. In three patients, the material in the common channel removed during surgery was fragile and consisted of more than 98% protein. Conclusion: The filling defects were protein plugs. The simultaneous occurrence of symptoms and signs may be explained by disturbances in bile and pancreatic secretory flow caused by a protein plug in the common channel.
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complete excision of the intrapancreatic portion of Choledochal Cysts
Journal of The American College of Surgeons, 1996Co-Authors: Hisami Ando, Kenitiro Kaneko, T Ito, Y Watanabe, T Seo, T Harada, F Ito, M Nagaya, T SugitoAbstract:Background Cyst excision is the treatment for patients with Choledochal Cysts. In general, many authors recommend intramural dissection between the outer and inner layers of the cyst or partial excision leaving part of the cyst in the pancreas to avoid pancreatic injury. However, because there are few large series with long-term follow-up periods, it remains unclear how much of the intrapancreatic portion of the cyst should be resected and what resection technique should be used. Study design During an 18-year period, 104 patients underwent excision of Choledochal Cysts at our hospitals. Twelve patients had partial excision of the cyst above the pancreas, and 17 had intramural dissection of the intrapancreatic portion. Seventy-five patients underwent complete excision of the intrapancreatic portion of the cyst by our new technique, in which the outer plane of the epiCholedochal plexus is dissected, exposing the narrow distal segment connecting the cyst to the pancreatic duct. Our new technique was compared retrospectively with the other two techniques. Results With our technique, the intrapancreatic cyst could be excised completely in 75 patients without any complications. Blood loss was significantly decreased when our technique was used compared to intramural excision. A pancreatic fistula occurred after intramural excision in one patient, and pancreatic stones formed several years after partial excision and intramural excision in three patients who proved to have residual cystic material in the pancreas. Conclusions Our operative technique is safe and effective for the complete excision of the intrapancreatic portion of a Choledochal cyst.