23. Phẫu thuật nội soi điều trị bất thường hợp lưu mật tụy không giãn đường mật ở trẻ em

Abstract

Pancreaticobiliary maljunction without bile duct dilatation (nondilated type) is rare in children. This is a condition where the common bile duct and pancreatic duct merge outside the Oddi’s sphincter, obstructing the circulation of the pancreatic juice and bile, risking reflux of pancreatic juice into the biliary tract and vice versa, causing biliary damage and recurrent pancreatitis. This is a retrospective review of 07 patients with abnormal pancreatic biliary confluence, recurrent acute pancreatitis, who underwent laparoscopic surgery at the General Surgery Center of the National Children's Hospital from January 2021 to April 2022. There were 07 patients including 4 males (57.1%) and 3 females (42.9%). The mean age of the patients was 58.8 ± 39.7 months. The average events of pancreatitis was 2.7 ± 0.5 times. The average diameter of the common bile duct was 4.95 ± 0.92mm. All patients had abnormal images of pancreaticobiliary maljunction without bile duct dilatation on magnetic resonance imaging or intraoperative cholangiography and underwent a laparoscopic hepatico-jejunostomy, connecting the common hepatic duct to the Roux-en-Y jejunum. There were 04 patients (57.1%) classified into type B pancreaticobiliary maljunction, 03 patients (42.9%) were classified as type C pancreaticobiliary maljunction. There was no mortality post surgery. There was 1 patient (14.3%) with postoperative bleeding complications, who was re-operated 1 day after surgery, remained stable postoperatively, and discharged after 9 days. The average postoperative treatment time at the General Surgery Center was 8.1 ± 2.8 days. In conclusion, laparoscopic extra-hepatic bile duct resection, hepatico-jejunostomy can be done with no mortality and minimal complication.