儿童胆总管囊肿的不同导管和血管解剖的腹腔镜治疗。

IF 1 4区 医学 Q3 SURGERY Journal of Minimal Access Surgery Pub Date : 2024-11-29 DOI:10.4103/jmas.jmas_255_24
Ankur Mandelia, Rohit Kapoor, Anju Verma, Pujana Kanneganti, Rajanikant R Yadav, Moinak Sen Sarma, Nishant Agarwal, Tarun Kumar, Biju Nair, Amit Buan
{"title":"儿童胆总管囊肿的不同导管和血管解剖的腹腔镜治疗。","authors":"Ankur Mandelia, Rohit Kapoor, Anju Verma, Pujana Kanneganti, Rajanikant R Yadav, Moinak Sen Sarma, Nishant Agarwal, Tarun Kumar, Biju Nair, Amit Buan","doi":"10.4103/jmas.jmas_255_24","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Variations in biliary ductal and hepatic vascular anatomy increase the complexity of surgery for choledochal cysts (CDC). The laparoscopic approach for the management of paediatric CDCs with variant anatomy is underreported. This study aimed to describe anatomical variations, operative techniques and early outcomes of laparoscopic hepaticojejunostomy (HJ) in children with CDCs and variant anatomy.</p><p><strong>Patients and methods: </strong>We conducted a retrospective review of 40 children who underwent laparoscopic CDC excision with HJ between 2019 and 2024 in a single surgical unit. Patients were divided into Group I (with anatomical variations, n = 20) and Group II (without variations, n = 20). Data on demographic details, clinical presentation, imaging findings, pre-operative interventions, ductal and vascular anatomical variations, surgical techniques, intraoperative variables, post-operative complications and outcomes were collected and analysed.</p><p><strong>Results: </strong>Ductal variations were found in 10 patients, with aberrant right posterior sectoral duct being the most common. Vascular variations were identified in 12 patients, with anteriorly crossing the right hepatic artery (RHA) being the most frequent. Group I had a higher mean age (7.32 vs. 3.57 years, P = 0.014) and longer operative times (415 vs. 364 min, P < 0.0001). Conversion to laparotomy was necessary in 10% of Group I and 15% of Group II patients ( P = 0.634). Post-operative complications, primarily minor (Clavien-Dindo Grade I or II), occurred in 40% of Group I and 30% of Group II ( P = 0.495). Group I had a significantly shorter time to full feeds (72 vs. 80 h, P = 0.015). Both groups had similar post-operative hospital stays and follow-up durations. At the last follow-up, all patients, except one with liver failure in Group II, were asymptomatic with no significant biliary dilatation or liver function abnormalities.</p><p><strong>Conclusion: </strong>Laparoscopic management of CDCs with variant ductal and vascular anatomy in children is feasible, safe and effective. Detailed pre-operative imaging, meticulous intraoperative assessment and tailored surgical techniques are crucial for successful outcomes.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0000,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Laparoscopic management of variant ductal and vascular anatomy in children with choledochal cysts.\",\"authors\":\"Ankur Mandelia, Rohit Kapoor, Anju Verma, Pujana Kanneganti, Rajanikant R Yadav, Moinak Sen Sarma, Nishant Agarwal, Tarun Kumar, Biju Nair, Amit Buan\",\"doi\":\"10.4103/jmas.jmas_255_24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Variations in biliary ductal and hepatic vascular anatomy increase the complexity of surgery for choledochal cysts (CDC). The laparoscopic approach for the management of paediatric CDCs with variant anatomy is underreported. This study aimed to describe anatomical variations, operative techniques and early outcomes of laparoscopic hepaticojejunostomy (HJ) in children with CDCs and variant anatomy.</p><p><strong>Patients and methods: </strong>We conducted a retrospective review of 40 children who underwent laparoscopic CDC excision with HJ between 2019 and 2024 in a single surgical unit. Patients were divided into Group I (with anatomical variations, n = 20) and Group II (without variations, n = 20). Data on demographic details, clinical presentation, imaging findings, pre-operative interventions, ductal and vascular anatomical variations, surgical techniques, intraoperative variables, post-operative complications and outcomes were collected and analysed.</p><p><strong>Results: </strong>Ductal variations were found in 10 patients, with aberrant right posterior sectoral duct being the most common. Vascular variations were identified in 12 patients, with anteriorly crossing the right hepatic artery (RHA) being the most frequent. Group I had a higher mean age (7.32 vs. 3.57 years, P = 0.014) and longer operative times (415 vs. 364 min, P < 0.0001). Conversion to laparotomy was necessary in 10% of Group I and 15% of Group II patients ( P = 0.634). Post-operative complications, primarily minor (Clavien-Dindo Grade I or II), occurred in 40% of Group I and 30% of Group II ( P = 0.495). Group I had a significantly shorter time to full feeds (72 vs. 80 h, P = 0.015). Both groups had similar post-operative hospital stays and follow-up durations. At the last follow-up, all patients, except one with liver failure in Group II, were asymptomatic with no significant biliary dilatation or liver function abnormalities.</p><p><strong>Conclusion: </strong>Laparoscopic management of CDCs with variant ductal and vascular anatomy in children is feasible, safe and effective. Detailed pre-operative imaging, meticulous intraoperative assessment and tailored surgical techniques are crucial for successful outcomes.</p>\",\"PeriodicalId\":48905,\"journal\":{\"name\":\"Journal of Minimal Access Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2024-11-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Minimal Access Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4103/jmas.jmas_255_24\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Minimal Access Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4103/jmas.jmas_255_24","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

摘要

导言:胆管和肝血管解剖结构的变化增加了胆总管囊肿手术的复杂性。腹腔镜方法的管理儿科疾病控制与变异解剖是少报道。本研究旨在描述患有cdc和不同解剖结构的儿童腹腔镜肝空肠吻合术(HJ)的解剖变异、手术技术和早期结果。患者和方法:我们对40名在2019年至2024年期间在单个手术单元接受腹腔镜CDC切除HJ的儿童进行了回顾性研究。患者分为ⅰ组(有解剖变异,n = 20)和ⅱ组(无解剖变异,n = 20)。收集和分析人口统计学细节、临床表现、影像学表现、术前干预、导管和血管解剖变异、手术技术、术中变量、术后并发症和结果的数据。结果:10例患者均出现导管变异,以右侧后部门导管异常最为常见。在12例患者中发现血管变异,以右肝动脉(RHA)前交叉最为常见。I组患者平均年龄较高(7.32 vs. 3.57岁,P = 0.014),手术时间较长(415 vs. 364 min, P < 0.0001)。10%的I组患者和15%的II组患者需要转为剖腹手术(P = 0.634)。术后并发症主要为轻微(Clavien-Dindo I级或II级),I组40%,II组30% (P = 0.495)。第1组至完全饲喂所需时间显著缩短(72 h vs. 80 h, P = 0.015)。两组术后住院时间和随访时间相似。在最后一次随访时,除II组1例肝功能衰竭外,所有患者均无症状,无明显胆道扩张或肝功能异常。结论:腹腔镜下治疗儿童导管及血管解剖结构变异的疾病是可行、安全、有效的。详细的术前影像,细致的术中评估和量身定制的手术技术是成功的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Laparoscopic management of variant ductal and vascular anatomy in children with choledochal cysts.

Introduction: Variations in biliary ductal and hepatic vascular anatomy increase the complexity of surgery for choledochal cysts (CDC). The laparoscopic approach for the management of paediatric CDCs with variant anatomy is underreported. This study aimed to describe anatomical variations, operative techniques and early outcomes of laparoscopic hepaticojejunostomy (HJ) in children with CDCs and variant anatomy.

Patients and methods: We conducted a retrospective review of 40 children who underwent laparoscopic CDC excision with HJ between 2019 and 2024 in a single surgical unit. Patients were divided into Group I (with anatomical variations, n = 20) and Group II (without variations, n = 20). Data on demographic details, clinical presentation, imaging findings, pre-operative interventions, ductal and vascular anatomical variations, surgical techniques, intraoperative variables, post-operative complications and outcomes were collected and analysed.

Results: Ductal variations were found in 10 patients, with aberrant right posterior sectoral duct being the most common. Vascular variations were identified in 12 patients, with anteriorly crossing the right hepatic artery (RHA) being the most frequent. Group I had a higher mean age (7.32 vs. 3.57 years, P = 0.014) and longer operative times (415 vs. 364 min, P < 0.0001). Conversion to laparotomy was necessary in 10% of Group I and 15% of Group II patients ( P = 0.634). Post-operative complications, primarily minor (Clavien-Dindo Grade I or II), occurred in 40% of Group I and 30% of Group II ( P = 0.495). Group I had a significantly shorter time to full feeds (72 vs. 80 h, P = 0.015). Both groups had similar post-operative hospital stays and follow-up durations. At the last follow-up, all patients, except one with liver failure in Group II, were asymptomatic with no significant biliary dilatation or liver function abnormalities.

Conclusion: Laparoscopic management of CDCs with variant ductal and vascular anatomy in children is feasible, safe and effective. Detailed pre-operative imaging, meticulous intraoperative assessment and tailored surgical techniques are crucial for successful outcomes.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
1.70
自引率
0.00%
发文量
151
审稿时长
36 weeks
期刊介绍: Journal of Minimal Access Surgery (JMAS), the official publication of Indian Association of Gastrointestinal Endo Surgeons, launched in early 2005. The JMAS, a quarterly publication, is the first English-language journal from India, as also from this part of the world, dedicated to Minimal Access Surgery. The JMAS boasts an outstanding editorial board comprising of Indian and international experts in the field.
期刊最新文献
A prospective observational study on intraperitoneal mesh repair for small ventral hernias: Why open prevails over laparoscopic approach. A rare complication after transabdominal preperitoneal hernia repair: Acute appendicitis. Closure of contralateral patent processus vaginalis in laparoscopic unilateral inguinal hernia repair: Is it necessary? Investigation of the relationship between helicobacter pylori positivity and colon polyps in simultaneous oesophagogastroduodenoscopy and colonoscopy procedures. Randomised comparison between navigation and non-navigation-assisted camera control performance in a surgical simulation task using a haptic device interface.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1