Case Report
Open Access
Laparoscopic Excision of Choledochal Cyst Type
I and Roux-En-Y Hepaticojejunostomy: A Case
Report with Video Illustration
Antoine El Asmar1*, Charbel Aoun1 and Ziad El Rassi2
1General Surgery Resident, Saint Georges Hospital University Medical Center, Faculty of Medicine, University of
Balamand, Beirut, Lebanon
2Associate Professor of Clinical Surgery, General and digestive Surgery-Oncologic Surgery, Saint Georges Hospital University Medical Center, Faculty of Medicine-University of Balamand, Beirut, Lebanon
2Associate Professor of Clinical Surgery, General and digestive Surgery-Oncologic Surgery, Saint Georges Hospital University Medical Center, Faculty of Medicine-University of Balamand, Beirut, Lebanon
*Corresponding author: Antoine El Asmar, General Surgery Resident, Saint Georges Hospital University Medical Center, Faculty of Medicine, University of Balamand, Beirut, Lebanon, E-mail:
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Received: April 24, 2017; Accepted: June 7 , 2017; Published: July 10, 2017
Citation: Antoine El Asmar, Ziad El Rassi,Charbel Aoun (2017) Laparoscopic Excision of Choledochal Cyst Type I and Roux-En-Y Hepaticojejunostomy: A Case Report with Video Illustration. Gastroenterol Pancreatol Liver Disord 5(1):1-2. Doi: http://dx.doi.org/10.15226/2374-815X/5/1/001100
Abstract
Choledochal cysts (CDC) are rare congenital anomalies
characterized by single or multiple cystic dilatations of the biliary
ducts.Total excision of CDC with Roux-en-Y hepaticoenterostomy is
the treatment of choice irrespective of age or symptomatology due
to its potential malignant transformation.Herein, the technique of
laparoscopic choledochal cyst excision and hepaticojejunostomy is
presented with an accompanying video.
Introduction
Choledochal cysts (CDC) are rare congenital anomalies
characterized by single or multiple cystic dilatations of the
biliary ducts. Adults usually present with abdominal pain,
infectious complications, or malignancy. Because of the use of
imaging, many asymptomatic patients are being diagnosed which
comprises around 10-36% of patients with CDC [1]. Total excision
of CDC with Roux-en-Y hepaticoenterostomy is the treatment of
choice irrespective of age or symptomatology due to its potential
malignant transformation. When doing conventional open right
subcostal incision, large incisions are appliedin addition to long
hospital stay [2]. However, laparoscopic CDC excision has shown
good success with minimal complications [3].
Herein, the technique of laparoscopic choledochal cyst excision and hepaticojejunostomy is presented with an accompanying video.
Herein, the technique of laparoscopic choledochal cyst excision and hepaticojejunostomy is presented with an accompanying video.
Case Presentation
A 58-year-old male patient presented to our institution with
epigastric pain of several months duration. Abdominal ultrasound
showedbile duct dilatation. In addition, his liver function tests
were disturbed. A CT scan and MRCP showed marked dilation of
the common bile duct starting slightly below the biliary confluence
proximally, till reaching the pancreatic margins distally. Imaging
showed no evidence of tumor. ERCP done showed no evidence of
tumor and EUS with FNA revealed a choledochal cyst type I with
negative FNA results on histopathological tests. Laparoscopic
excision of the choledochal cyst and Roux-en-Y
Hepaticojejunostomy was performed. No intra or postoperative
complications were encountered and the patient was discharged
home on day 5 after drains removal and feeding.
Performing such a major procedure, in laparoscopic means, allowed for faster patient recovery and discharge, with less morbidity. Such intervention should be performed by a surgeon with expertise in the hepatobiliary field as well as minimally invasive procedures. The video we present shows the main steps in such an operation, along with few tips and guidelines for a safe and complete surgical intervention.
Performing such a major procedure, in laparoscopic means, allowed for faster patient recovery and discharge, with less morbidity. Such intervention should be performed by a surgeon with expertise in the hepatobiliary field as well as minimally invasive procedures. The video we present shows the main steps in such an operation, along with few tips and guidelines for a safe and complete surgical intervention.
Conclusion
With time, Laparoscopic excision of the choledochal cyst and
Roux-en-Y Hepaticojejunostomy should become more popular
and adopted by surgeons. Although such a surgical intervention
requires advanced laparoscopic skills, the new technologies,
devices and laparoscopic instruments will allow an easier
process in performance. The associated tremendous decrease
in post-operative morbidity as well as hospital stay should drive
laparoscopic surgeons to at least attempt this technique before
switching to its open counterpart.
- Ronnekleiv-Kelly, Sean MS, Kevin CE, Aslam P, Timothy M. Management of choledochal cysts. Current opinion in gastroenterology. 2016;32(3):225-231. doi: 10.1097/MOG.0000000000000256
- Li Long, Feng W, Jing-Bo F, Qi-Zhi Y, Gang L, Liu-Ming H, et al. Laparoscopic-assisted total cyst excision of choledochal cyst and Rouxen-Y hepatoenterostomy. Journal of pediatric surgery. 2004;39(11):1663-1666.
- Bethany J Slater, Steven S Rothenberg. Laparoscopic Treatment of Choledochal Cysts. Springer International Publishing. 2017;581-591.
