Laparoscopic reconstructive operations for malformations of the common bile duct in children

Objective. Presentation of experience in the use of laparoscopic reconstructive surgeries for common bile duct (CBD) cysts in children. Material and methods. During the period from 2011 to 2023, 22 children aged from 2 to 13 years (average age — 4.4 years) with choledochal cysts were operated on. All children were admitted to the hospital with abdominal pain syndrome. Screening ultrasound revealed a cystic dilatation of the common bile duct, which was subsequently confirmed by MRCP. After verification of the diagnosis, all children underwent laparoscopic cyst excision with hepaticojejunostomy on a Roux-en-Y loop. Results. The duration of the operation ranged from 150 to 190 minutes (average time — 170 minutes). No intraoperative complications were noted. Intraoperative blood loss did not exceed 100 ml. The duration of patients’ stay in the intensive care bed ranged from 2 to 7 days (average value — 3.2 days). In 1 (4.5%) patient, bleeding occurred 10 hours after surgery, which required relaparoscopy and sanitation of the abdominal cavity. In 3 (13.6%) cases, severe bile leakage was noted in the early postoperative period, due to partial failure of the hepatico-jejunal anastomosis. All children were discharged from the hospital 10-13 days after surgery. Follow-up observation was carried out from 3 to 12 years after surgical treatment. In 3 (13.6%) children, the recurrent cholangitis were noted after the first operation. The total number of early postoperative operations was 18%, late 13.6%. Conclusion. According to the literature and the results of our own observations, laparoscopic operations in children with choledochal cysts are safe and effective and have great prospects due to the minimal traumatic nature of these interventions.