Choledochal cysts: Special emphasis on the usefulness of intraoperative endoscopy

Miyano, Takeshi; Yamataka, Atsuyuki; Kato, Yoshifumi; Kohno, Sumio; Fujiwara, Toshio

doi:10.1016/0022-3468(95)90061-6

Cited by 55 publications

(51 citation statements)

References 9 publications

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“…Detailed descriptions of operative techniques are provided elsewhere 2,77,79 . Operative cholangiography and cyst endoscopy have been recommended to clarify the biliary anatomy 52,53,80 , and are particularly useful for revealing the presence of proximal ductal stenosis, calculi and aberrant ducts.…”

Section: Operative Techniquementioning

confidence: 99%

Bile duct cysts in adults

Søreide

Kørner

Havnen

et al. 2004

British Journal of Surgery

180

191

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An increasing rate of occurrence of bile duct cyst is reported in adults. Type IV cysts are more frequent in adults than children. Presentation tends to be non-specific abdominal discomfort. Related hepatobiliary or pancreatic disease frequently precedes recognition, and may complicate the postoperative course. Surgical treatment aims to relieve complications deriving from the cysts and to reduce the significant risk of malignant change within the biliary tree. Complete cyst resection, cholecystectomy and Roux-en-Y hepaticojejunostomy reconstruction is standard. Controversy exists about the role of hepatic resection in type IV and V cysts, and the role of minimally invasive and laparoscopic treatment. In general, the outcome is good and a near-zero mortality rate has been reported in institutional series over the past decade.

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Section: Operative Techniquementioning

confidence: 99%

Bile duct cysts in adults

Søreide

Kørner

Havnen

et al. 2004

British Journal of Surgery

180

191

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“…Strictures can be dilated, stones can be removed and mucosal irregularities can be biopsied. 27 A similar proactive approach should be adopted for the common channel, which should be scoped (if possible) and cleaned of occluding debris or stones. Occasionally, a transduodenal sphincteroplasty may be warranted if there is ampullary stenosis and a dilated channel.…”

Section: Managementmentioning

confidence: 99%

Congenital Choledochal Malformation: Not Just a Problem for Children

Dabbas

Davenport

2009

annals

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Choledochal cysts remain relatively uncommon in Western Europe and the US, although they are appreciably more common in Asia. Their aetiology remains obscure although abnormalities of the pancreaticobiliary junction may be the primary pathology in some, with biliary dilatation following reflux of activated pancreatic secretions. Most anomalies will present in childhood with obstructive jaundice or abdominal pain; a proportion may only present for the first time during adulthood, and some of these will show malignant transformation. The classical triad of pain, jaundice and a palpable mass is, however, not common. Complete cyst excision, where possible, and biliary reconstruction remain the aims for most types although there is still some controversy about the type of reconstruction. Laparoscopic reconstruction is possible but is still very much an advanced technique. The risk of long-term problems post-surgery is significant. Whether this is due to recurrent pancreatitis secondary to the retained common channel and/or a distal stump, or due to the development of biliary tract malignancy is still a cause for concern and indicates the need for adequate, prolonged follow-up.

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“…Using this technique, it was possible to determine the level of resection of the IPCC and irrigate the IPCC to wash out any debris or protein plugs. We attributed our lower incidence of postoperative complications to IE [11,12] and found a ureteroscope was best for IE because the IPCC could be observed at the same time as debris could be washed away because the flow of normal saline through a ureteroscope is constant. We adapted this concept for use during lapCC using an extra trocar inserted through a minimal incision to measure the exact length of the IPCC in the same way as we routinely measure the length of rectourethral fistulas intraoperatively during laparoscopic anorectoplasty for male imperforate anus [13].…”

Section: Discussionmentioning

confidence: 91%

“…To dissect the IPCC more accurately, we previously reported the use of intraoperative endoscopy (IE) during CC excision [11]. Using this technique, it was possible to determine the level of resection of the IPCC and irrigate the IPCC to wash out any debris or protein plugs.…”

Section: Discussionmentioning

confidence: 99%

Refining the intraoperative measurement of the distal intrapancreatic part of a choledochal cyst during laparoscopic repair allows near total excision

et al. 2015

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During surgery for choledochal cyst (CC), any intrapancreatic CC (IPCC) must also be excised to prevent postoperative pancreatitis and stone formation. We report our technique for laparoscopic total IPCC excision (n = 16; mean age 6.0 years). We insert a fine ureteroscope with a light source into the opened CC through an extra 3.9-mm trocar placed in the epigastrium through a minute incision to identify the pancreatic duct orifice. By pulling the end of the ureteroscope emerging from the trocar gently to withdraw the tip from the pancreatic duct to where distal dissection was ceased under laparoscopic view, the IPCC can be measured. If longer than 5 mm, the distal CC is dissected further caudally until it is less than 5 mm. For accuracy, the distal CC is elevated with a suture that is exteriorized and clamped to provide constant traction. The IPCC was able to be measured in 11/16 (68 %). Initial lengths measured were 3-10 mm (5.2 ± 2.7 mm). Final IPCC were all 5 mm or less. Surgery was uncomplicated without any pancreatic duct injury and postoperative recovery was unremarkable. Follow-up MRI at 32 months showed no IPCC in any case. Measuring the IPCC enables total CC excision, thus reducing the potential for postoperative complications.

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Choledochal cysts: Special emphasis on the usefulness of intraoperative endoscopy

Cited by 55 publications

References 9 publications

Bile duct cysts in adults

Bile duct cysts in adults

Congenital Choledochal Malformation: Not Just a Problem for Children

Refining the intraoperative measurement of the distal intrapancreatic part of a choledochal cyst during laparoscopic repair allows near total excision

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