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Laparoscopic Management of Choledochal Cyst-Technical Modifications and Outcome Analysis
Background Choledochal cyst (CDC) is a well described albeit rare clinical entity. Complete cyst excision with biliary-enteric reconstruction is the recommended treatment for Todani type I, II, and IVA cysts to prevent complications. The aim of this study is to evaluate outcomes of laparoscopic CDC...
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| Published in: | World journal of surgery 2015-10, Vol.39 (10), p.2550-2556 |
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| container_title | World journal of surgery |
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| creator | Senthilnathan, Palanisamy Patel, Nikunj D. Nair, Arun S. Nalankilli, V. P. Vijay, Anand Palanivelu, Chinnusamy |
| description | Background
Choledochal cyst (CDC) is a well described albeit rare clinical entity. Complete cyst excision with biliary-enteric reconstruction is the recommended treatment for Todani type I, II, and IVA cysts to prevent complications. The aim of this study is to evaluate outcomes of laparoscopic CDC excision from a tertiary care center.
Methods
This is a retrospective analysis of prospectively collected data of 110 patients who underwent laparoscopic cyst excision and biliary-enteric reconstruction for CDC type I and IVA from 1998 to 2013.
Results
Out of 110 patients, 55 were children (16 years) with mean age 21.19 ± 17.75 years and male:female ratio of 1:2.14. Abdominal pain was the most common presenting symptom (59.09 %). Surprisingly, 32.73 % of adults presented with incidentally detected cyst. Type I cyst was the most common (71.82 %) with mean size of 4.67 ± 1.59 cm. Blood loss (56.0 ± 16.62 vs. 76.55 ± 26.61 ml) and operative time (199.8 ± 44.66 vs. 251.6 ± 54.25 min) were significantly low in pediatric group. Three adults required conversion. Overall complication rate was 10 %. Re-exploration rate was 1.81 % with one patient died post-operatively. Mean hospital stay was significantly low in children (5.9 ± 1.39 vs. 7.0 ± 2.66 days). Median follow-up was 60 months (8–110). Cholangitis developed in six patients with three having anastomotic stricture requiring intervention.
Conclusion
Laparoscopic excision of CDC is safe and feasible. Surgery should be performed early as outcomes are better in pediatric age as compared to adults. |
| doi_str_mv | 10.1007/s00268-015-3111-8 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1708904275</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1708904275</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4927-c7e60e336300cd8a61b4026f97dc01a4ae1b80a110a50fa44e50341cddca01d93</originalsourceid><addsrcrecordid>eNqFkMFu1DAQhi3Uim4LD8AFReqFS-hM7MTJsazYAtpqDyyCmzVrT7qpkniJE6F9e1ylIFSp4jRj6ft_jT8h3iC8RwB9FQCyokwB81QiYlq-EAtUMkszmckTsQBZqLijPBPnIdwDoC6geCnOsjh0IdVC_FjTgQYfrD80Nrmlnu64435MfJ0s975l5-2e2mR5DGO6ZbvvGxuft941ddzGxvchod4lm2m0vuPkuqf2GJrwSpzW1AZ-_TgvxLfVx-3yU7re3HxeXq9Tq6pMp1ZzASxlIQGsK6nAnYqfqivtLCApYtyVQIhAOdSkFOcgFVrnLAG6Sl6Id3PvYfA_Jw6j6ZpguW2pZz8FgxrKClSm84hePkHv_TTEe2dKSShBRQpnykYtYeDaHIamo-FoEMyDdjNrN1G7edBuyph5-9g87Tp2fxN_PEegmoFfTcvH_zea71--fliBzlHHbDZnQ4z1dzz8c_azF_0GG1KdDA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1708430804</pqid></control><display><type>article</type><title>Laparoscopic Management of Choledochal Cyst-Technical Modifications and Outcome Analysis</title><source>Springer Nature</source><creator>Senthilnathan, Palanisamy ; Patel, Nikunj D. ; Nair, Arun S. ; Nalankilli, V. P. ; Vijay, Anand ; Palanivelu, Chinnusamy</creator><creatorcontrib>Senthilnathan, Palanisamy ; Patel, Nikunj D. ; Nair, Arun S. ; Nalankilli, V. P. ; Vijay, Anand ; Palanivelu, Chinnusamy</creatorcontrib><description>Background
Choledochal cyst (CDC) is a well described albeit rare clinical entity. Complete cyst excision with biliary-enteric reconstruction is the recommended treatment for Todani type I, II, and IVA cysts to prevent complications. The aim of this study is to evaluate outcomes of laparoscopic CDC excision from a tertiary care center.
Methods
This is a retrospective analysis of prospectively collected data of 110 patients who underwent laparoscopic cyst excision and biliary-enteric reconstruction for CDC type I and IVA from 1998 to 2013.
Results
Out of 110 patients, 55 were children (<16 years) and 55 were adults (>16 years) with mean age 21.19 ± 17.75 years and male:female ratio of 1:2.14. Abdominal pain was the most common presenting symptom (59.09 %). Surprisingly, 32.73 % of adults presented with incidentally detected cyst. Type I cyst was the most common (71.82 %) with mean size of 4.67 ± 1.59 cm. Blood loss (56.0 ± 16.62 vs. 76.55 ± 26.61 ml) and operative time (199.8 ± 44.66 vs. 251.6 ± 54.25 min) were significantly low in pediatric group. Three adults required conversion. Overall complication rate was 10 %. Re-exploration rate was 1.81 % with one patient died post-operatively. Mean hospital stay was significantly low in children (5.9 ± 1.39 vs. 7.0 ± 2.66 days). Median follow-up was 60 months (8–110). Cholangitis developed in six patients with three having anastomotic stricture requiring intervention.
Conclusion
Laparoscopic excision of CDC is safe and feasible. Surgery should be performed early as outcomes are better in pediatric age as compared to adults.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-015-3111-8</identifier><identifier>PMID: 26067634</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Adolescent ; Adult ; Adult Group ; Aged ; Blood Loss, Surgical ; Cardiac Surgery ; Child ; Child, Preschool ; Cholangitis ; Cholangitis - etiology ; Choledochal Cyst ; Choledochal Cyst - surgery ; Conversion to Open Surgery ; Female ; General Surgery ; Humans ; Laparoscopy - adverse effects ; Laparoscopy - methods ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Operative Time ; Original Scientific Report ; Pancreatitis ; Pediatric Group ; Reoperation ; Retrospective Studies ; Surgery ; Thoracic Surgery ; Treatment Outcome ; Vascular Surgery ; Young Adult</subject><ispartof>World journal of surgery, 2015-10, Vol.39 (10), p.2550-2556</ispartof><rights>Société Internationale de Chirurgie 2015</rights><rights>2015 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4927-c7e60e336300cd8a61b4026f97dc01a4ae1b80a110a50fa44e50341cddca01d93</citedby><cites>FETCH-LOGICAL-c4927-c7e60e336300cd8a61b4026f97dc01a4ae1b80a110a50fa44e50341cddca01d93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26067634$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Senthilnathan, Palanisamy</creatorcontrib><creatorcontrib>Patel, Nikunj D.</creatorcontrib><creatorcontrib>Nair, Arun S.</creatorcontrib><creatorcontrib>Nalankilli, V. P.</creatorcontrib><creatorcontrib>Vijay, Anand</creatorcontrib><creatorcontrib>Palanivelu, Chinnusamy</creatorcontrib><title>Laparoscopic Management of Choledochal Cyst-Technical Modifications and Outcome Analysis</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
Choledochal cyst (CDC) is a well described albeit rare clinical entity. Complete cyst excision with biliary-enteric reconstruction is the recommended treatment for Todani type I, II, and IVA cysts to prevent complications. The aim of this study is to evaluate outcomes of laparoscopic CDC excision from a tertiary care center.
Methods
This is a retrospective analysis of prospectively collected data of 110 patients who underwent laparoscopic cyst excision and biliary-enteric reconstruction for CDC type I and IVA from 1998 to 2013.
Results
Out of 110 patients, 55 were children (<16 years) and 55 were adults (>16 years) with mean age 21.19 ± 17.75 years and male:female ratio of 1:2.14. Abdominal pain was the most common presenting symptom (59.09 %). Surprisingly, 32.73 % of adults presented with incidentally detected cyst. Type I cyst was the most common (71.82 %) with mean size of 4.67 ± 1.59 cm. Blood loss (56.0 ± 16.62 vs. 76.55 ± 26.61 ml) and operative time (199.8 ± 44.66 vs. 251.6 ± 54.25 min) were significantly low in pediatric group. Three adults required conversion. Overall complication rate was 10 %. Re-exploration rate was 1.81 % with one patient died post-operatively. Mean hospital stay was significantly low in children (5.9 ± 1.39 vs. 7.0 ± 2.66 days). Median follow-up was 60 months (8–110). Cholangitis developed in six patients with three having anastomotic stricture requiring intervention.
Conclusion
Laparoscopic excision of CDC is safe and feasible. Surgery should be performed early as outcomes are better in pediatric age as compared to adults.</description><subject>Abdominal Surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Adult Group</subject><subject>Aged</subject><subject>Blood Loss, Surgical</subject><subject>Cardiac Surgery</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cholangitis</subject><subject>Cholangitis - etiology</subject><subject>Choledochal Cyst</subject><subject>Choledochal Cyst - surgery</subject><subject>Conversion to Open Surgery</subject><subject>Female</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Laparoscopy - adverse effects</subject><subject>Laparoscopy - methods</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Operative Time</subject><subject>Original Scientific Report</subject><subject>Pancreatitis</subject><subject>Pediatric Group</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><subject>Young Adult</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqFkMFu1DAQhi3Uim4LD8AFReqFS-hM7MTJsazYAtpqDyyCmzVrT7qpkniJE6F9e1ylIFSp4jRj6ft_jT8h3iC8RwB9FQCyokwB81QiYlq-EAtUMkszmckTsQBZqLijPBPnIdwDoC6geCnOsjh0IdVC_FjTgQYfrD80Nrmlnu64435MfJ0s975l5-2e2mR5DGO6ZbvvGxuft941ddzGxvchod4lm2m0vuPkuqf2GJrwSpzW1AZ-_TgvxLfVx-3yU7re3HxeXq9Tq6pMp1ZzASxlIQGsK6nAnYqfqivtLCApYtyVQIhAOdSkFOcgFVrnLAG6Sl6Id3PvYfA_Jw6j6ZpguW2pZz8FgxrKClSm84hePkHv_TTEe2dKSShBRQpnykYtYeDaHIamo-FoEMyDdjNrN1G7edBuyph5-9g87Tp2fxN_PEegmoFfTcvH_zea71--fliBzlHHbDZnQ4z1dzz8c_azF_0GG1KdDA</recordid><startdate>201510</startdate><enddate>201510</enddate><creator>Senthilnathan, Palanisamy</creator><creator>Patel, Nikunj D.</creator><creator>Nair, Arun S.</creator><creator>Nalankilli, V. P.</creator><creator>Vijay, Anand</creator><creator>Palanivelu, Chinnusamy</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>201510</creationdate><title>Laparoscopic Management of Choledochal Cyst-Technical Modifications and Outcome Analysis</title><author>Senthilnathan, Palanisamy ; Patel, Nikunj D. ; Nair, Arun S. ; Nalankilli, V. P. ; Vijay, Anand ; Palanivelu, Chinnusamy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4927-c7e60e336300cd8a61b4026f97dc01a4ae1b80a110a50fa44e50341cddca01d93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Abdominal Surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Adult Group</topic><topic>Aged</topic><topic>Blood Loss, Surgical</topic><topic>Cardiac Surgery</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cholangitis</topic><topic>Cholangitis - etiology</topic><topic>Choledochal Cyst</topic><topic>Choledochal Cyst - surgery</topic><topic>Conversion to Open Surgery</topic><topic>Female</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Laparoscopy - adverse effects</topic><topic>Laparoscopy - methods</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Operative Time</topic><topic>Original Scientific Report</topic><topic>Pancreatitis</topic><topic>Pediatric Group</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Senthilnathan, Palanisamy</creatorcontrib><creatorcontrib>Patel, Nikunj D.</creatorcontrib><creatorcontrib>Nair, Arun S.</creatorcontrib><creatorcontrib>Nalankilli, V. P.</creatorcontrib><creatorcontrib>Vijay, Anand</creatorcontrib><creatorcontrib>Palanivelu, Chinnusamy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Senthilnathan, Palanisamy</au><au>Patel, Nikunj D.</au><au>Nair, Arun S.</au><au>Nalankilli, V. P.</au><au>Vijay, Anand</au><au>Palanivelu, Chinnusamy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Laparoscopic Management of Choledochal Cyst-Technical Modifications and Outcome Analysis</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2015-10</date><risdate>2015</risdate><volume>39</volume><issue>10</issue><spage>2550</spage><epage>2556</epage><pages>2550-2556</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
Choledochal cyst (CDC) is a well described albeit rare clinical entity. Complete cyst excision with biliary-enteric reconstruction is the recommended treatment for Todani type I, II, and IVA cysts to prevent complications. The aim of this study is to evaluate outcomes of laparoscopic CDC excision from a tertiary care center.
Methods
This is a retrospective analysis of prospectively collected data of 110 patients who underwent laparoscopic cyst excision and biliary-enteric reconstruction for CDC type I and IVA from 1998 to 2013.
Results
Out of 110 patients, 55 were children (<16 years) and 55 were adults (>16 years) with mean age 21.19 ± 17.75 years and male:female ratio of 1:2.14. Abdominal pain was the most common presenting symptom (59.09 %). Surprisingly, 32.73 % of adults presented with incidentally detected cyst. Type I cyst was the most common (71.82 %) with mean size of 4.67 ± 1.59 cm. Blood loss (56.0 ± 16.62 vs. 76.55 ± 26.61 ml) and operative time (199.8 ± 44.66 vs. 251.6 ± 54.25 min) were significantly low in pediatric group. Three adults required conversion. Overall complication rate was 10 %. Re-exploration rate was 1.81 % with one patient died post-operatively. Mean hospital stay was significantly low in children (5.9 ± 1.39 vs. 7.0 ± 2.66 days). Median follow-up was 60 months (8–110). Cholangitis developed in six patients with three having anastomotic stricture requiring intervention.
Conclusion
Laparoscopic excision of CDC is safe and feasible. Surgery should be performed early as outcomes are better in pediatric age as compared to adults.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>26067634</pmid><doi>10.1007/s00268-015-3111-8</doi><tpages>7</tpages></addata></record> |
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| subjects | Abdominal Surgery Adolescent Adult Adult Group Aged Blood Loss, Surgical Cardiac Surgery Child Child, Preschool Cholangitis Cholangitis - etiology Choledochal Cyst Choledochal Cyst - surgery Conversion to Open Surgery Female General Surgery Humans Laparoscopy - adverse effects Laparoscopy - methods Length of Stay Male Medicine Medicine & Public Health Middle Aged Operative Time Original Scientific Report Pancreatitis Pediatric Group Reoperation Retrospective Studies Surgery Thoracic Surgery Treatment Outcome Vascular Surgery Young Adult |
| title | Laparoscopic Management of Choledochal Cyst-Technical Modifications and Outcome Analysis |
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