Preliminary Experience with Continuous Submucosal Anastomosis in Small-Diameter Hepaticojejunostomy during Single-Port Laparoscopic Choledochal Cyst Surgery in Children.

IF 1.5 3区 医学 Q2 PEDIATRICS
European Journal of Pediatric Surgery Pub Date : 2024-10-01 Epub Date: 2023-07-19 DOI:10.1055/a-2133-5202
Yingming Tang, Jie Zhang, Miao Luo, Fei Li, Huang Huang, Zhou Zhou, Xia Fan, Zhijie Qin, Guoqing He, Yize Zhuang
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引用次数: 0

Abstract

Purpose:  Hepaticojejunostomy anastomosis (HJA) is the most challenging aspect in single-port laparoscopic choledochal cystectomy and Roux-en-Y hepaticojejunostomy (SPCH) in children, especially in small-diameter anastomoses (diameters less than 5 mm), which are more susceptible to anastomotic stricture. We developed the continuous submucosal technique for HJA (CS-HJA) to lessen postoperative complications. The purpose of this study is to introduce our preliminary experiences with CS-HJA.

Methods:  We retrospectively analyzed all available clinical data of children who underwent SPCH surgery between March 2020 and October 2022. We operated with CS-HJA on 10 children who were diagnosed with small-diameter hepaticojejunostomy (diameter less than 5 mm). Data collection mainly included demographic information, imaging data, perioperative details, and postoperative outcomes. Ten patients were included in this study. The average patient age was 55.2 months; the age range was 3 to 120 months, and the average weight was 11.6 kg; male-female ratio was 1:9. The choledocho had fusiform dilatation in five cases and cystic dilatation in five cases. There was no dilatation of the left and right hepatic ducts or intrahepatic bile ducts in all patients. All patients had no dilatation of the left and right hepatic ducts or intrahepatic bile ducts. All patients underwent a single-port laparoscopic bile-intestinal anastomosis using a submucosal jejunal anastomosis technique. Analysis of the duration of the bile-intestinal anastomosis, the length of the child's stay in the hospital after surgery, the intraoperative complications, and the postoperative complications was performed.

Results:  All the 10 patients underwent successful SPCH by CS-HJA technique. The average length of time for hepaticojejunostomy ranged from 22 to 40 minutes, and the postoperative hospital stay was 5.2 to 9.2 days. There were no instances of bile leakage following the operation. At 17 to 30 months of follow-up, there was no abdominal pain or jaundice, and the reexamination of transaminases, bilirubin, and amylase were normal. Ultrasonography showed no bile duct stricture or dilated bile ducts, and the incision is elegant, and the families of the patients were satisfied.

Conclusion:  In SPCH surgery in children, the CS-HJA technique is safe and feasible for small-diameter hepaticojejunostomy.

儿童单孔腹腔镜胆总管囊肿小直径肝空肠吻合术中粘膜下连续吻合的初步体会。
目的: 肝肠吻合术(HJA)是儿童单口腹腔镜胆总管膀胱切除术和肝肠Roux-en-Y吻合术(SPCH)中最具挑战性的方面,尤其是在小直径吻合(直径小于5 mm),更容易发生吻合口狭窄。为了减少术后并发症,我们开发了HJA的连续黏膜下技术(CS-HJA)。本研究的目的是介绍我们使用CS-HJA的初步经验。方法: 我们回顾性分析了2020年3月至2022年10月期间接受SPCH手术的儿童的所有可用临床数据。我们使用CS-HJA对10名被诊断为小直径肝肠造口术(直径小于5 mm)。数据收集主要包括人口统计学信息、影像学数据、围手术期细节和术后结果。本研究包括10名患者。患者平均年龄55.2个月;年龄在3到120个月之间,平均体重11.6 公斤男女比例为1:9。胆总管梭形扩张5例,囊性扩张5例。所有患者均未出现左右肝管或肝内胆管扩张。所有患者均未出现左右肝管或肝内胆管扩张。所有患者均采用黏膜下空肠吻合技术进行了单端口腹腔镜胆肠吻合。分析了胆肠吻合术的持续时间、术后患儿住院时间、术中并发症和术后并发症。结果: 10例患者均采用CS-HJA技术成功进行了SPCH。肝肠造口术的平均时间为22-40分钟 术后住院5.2~9.2天。手术后没有出现胆汁渗漏的情况。随访17至30个月,无腹痛或黄疸,转氨酶、胆红素和淀粉酶复查正常。超声检查无胆管狭窄或扩张,切口美观,患者家属满意。结论: 在儿童SPCH手术中,CS-HJA技术是安全可行的小直径肝肠造口术。
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来源期刊
CiteScore
3.90
自引率
5.60%
发文量
66
审稿时长
6-12 weeks
期刊介绍: This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.
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