Abstract:
Objective To study the pathologic features and minimal invasive surgical procedures for pediatric Caroli disease.
Methods From July 2016 to October 2018, 2 children suffered from Caroli disease underwent surgery in our hospital. The pathologic results and surgery techniques were reviewed. Case 1 was a girl with age of three years and 2 months, weight of 14.2 kg, height of 100 cm and body surface area of 0.64 m
2. Case 2 was a 9 year-old girl with weight of 34.2 kg, height of 135 cm and body surface area of 1.11 m
2.Plain and enhanced scanning of CT and MRCP examinations were performed before operation. Laparoscopic total intracorporeal correction of choledochal cyst was performed for case 1. Robotic correction of choledochal cyst was performed for case 2. Techniques included cyst excision, Roux-en-Y hepaticojejunostomy and side jejunotomy.
Results The operating time, pneumoperitonium time and estimated blood loss were 225 minutes, 190 minutes, 10 ml for laparoscopic total intracorporeal correction of choledochal cyst in case1; and 300 minutes, 270 minutes, 80 ml for robotic correction of choledochal cyst in case 2, respectively. Both of them experienced uneventful recovery postoperatively, without bile fistula, bleeding and infection, et al. No complications related to pneumoperitoneum occurred. Case 1 was followed up for 1 year and 7 months. No complications such as cholelithiasis occurred. The levels of total bile acid, bilirubin and aminotransferase enzymes were normal. For case 2, the above indicators were declined to the normal values,and she was discharged from hospital at 19 days postoperatively.
Conclusion Children suffered from Caroli disease present with saccular dilations of intrahepatic bile duct, and anomalous junction of the pancreatic and common bile ducts. Laparoscopic or robotic intracorporeal correction of choledochal cysts is safe and feasible for Caroli disease in children, including choledochal cyst excision,Roux-en-Y hepaticojejunostomy of the colon anteriorly, and side jejunotomy with laparoscopic linear stapler.