Laparoscopic treatment of congenital choledochal cyst and hepaticojejunostomy with extracorporeal Roux-en-Y anastomosis: technical aspects and early experience with three cases

Abstract

Choledochal cyst (CDC) is a congenital dilatation of the extra and/or intrahepatic bile ducts and it is a rare condition in western countries. Classical treatment consists of cyst excision and hepaticojejunostomy. The first case of a laparoscopic CDC excision was described in 1995 and since that time an increasing number of institutions have adopted this technique, with good success. We describe our early experience of 3 cases of CDC treated with laparoscopic approach. We used a 10 mm umbilical port for the camera, and four 3-5 mm operative ports. We performed the laparoscopic removal of the cyst and gallbladder, videoassisted preparation of the Roux-en-Y loop and laparoscopic hepaticjejunostomy. No post-operative complications occurred. Laparoscopic excision of CDCs has been supposed to give better observation, a better cosmetic result, potentially less postoperative pain, and a shorter recovery. The main argument for performing an extracorporeal anastomosis is that it decreases the operative time. We recommend caution to prevent injury to the pancreatic duct and biliary structures during dissection and anastomosis. Lifelong surveillance is mandatory, even after resection of the choledochal cyst.

Minimally-invasive neonatal surgery: laparoscopic excision of choledochal cysts in neonates

“…The surgical treatment of choice consists of cyst excision and biliary bypass [123]. Improvements in surgical techniques and instruments have made laparoscopic excision of the cyst (LEC) and Roux-en-Y hepaticojejunostomy the preferred method in children and adults [4567]. Laparoscopic hepaticojejunostomy in children with CC has been shown safe with lower morbidity rates than open procedures.…”

Quiste de colédoco Todani tipo IVa en un recién nacido

“…2,8,11 El tratamiento consiste en la resección quirúrgica del quiste y la realización de una hepato-yeyunoanastomosis en Y de Roux. 2,7,13 La cirugía disminuye las complicaciones relacionadas con los QC como colangitis, pancreatitis, absceso hepático, peritonitis biliar por ruptura del quiste, fibrosis del conducto común, cálculos del colédoco, hipertensión portal, hemorragia digestiva, varices esofágicas y cirrosis. 1,3,6 Además se ha descrito que los QC se asocian al desarrollo de colangiocarcinoma extrahepático o adenocarcinomas a largo plazo, con un riesgo 20 veces mayor que el de la población general.…”

Laparoscopic excision of type II choledochal cyst arising from the intrapancreatic common bile duct in an adult

“…2 Excision of the lower cyst, which arises from the intrapancreatic common bile duct (CBD), is technically demanding because of its location. Although laparoscopic treatment is being widely performed for CDC, [3][4][5] there have been no reports of laparoscopic excision of a lower type II CDC. We present our experience of laparoscopic excision of a type II CDC arising from the intrapancreatic CBD.…”