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

  • Mario Lima Department of Pediatric Surgery, S. Orsola Malpighi Hospital-University of Bologna, Bologna, Italy.
  • Tommaso Gargano | tommaso.gargano2@unibo.it Department of Pediatric Surgery, S. Orsola Malpighi Hospital-University of Bologna, Bologna, Italy.
  • Giovanni Ruggeri Department of Pediatric Surgery, S. Orsola Malpighi Hospital-University of Bologna, Bologna, Italy.
  • Francesca Destro Department of Pediatric Surgery, S. Orsola Malpighi Hospital-University of Bologna, Bologna, Italy.
  • Michela Maffi Department of Pediatric Surgery, S. Orsola Malpighi Hospital-University of Bologna, Bologna, Italy.

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.

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Published
2016-06-27
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Section
Case Reports
Keywords:
Choledochal cyst, Laparoscopy, Pediatric surgery
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How to Cite
Lima, M., Gargano, T., Ruggeri, G., Destro, F., & Maffi, M. (2016). Laparoscopic treatment of congenital choledochal cyst and hepaticojejunostomy with extracorporeal Roux-en-Y anastomosis: technical aspects and early experience with three cases. La Pediatria Medica E Chirurgica, 38(2). https://doi.org/10.4081/pmc.2016.125