Abstract
Choledochal cysts are increasingly diagnosed as an incidental finding. 1 Given the long-term risk of developing cholangiocarcinoma, excision is recommended, 2 depending on the patient's comorbidities. Laparoscopic surgery for choledochal cysts is safe and associated with good cosmesis and a fast postoperative recovery. 3 –5 We present a 45-year-old woman who was investigated for upper abdominal pain and was shown to have a Type IVb choledochal cyst on ultrasonography and magnetic resonance cholangiopancreatography. She had no other significant medical history. The operation was performed under general anesthesia, with the patient supine and the main operator standing on the patient's right-hand side. After adhesiolysis and dissection around the gallbladder and choledochal cyst, the cystic duct was isolated and cannulated. Intraoperative cholangiogram confirmed the preoperative anatomy and a sample of fluid taken from the distal end of the cystic showed a high amylase level consistent with the pancreatic duct. The proximal bile duct was divided with a laparoscopic stapler. Further dissection of the choledochal cyst from the surrounding tissue proceeded distally to the point at which it tapered down to the junction with the pancreactic duct. After excision of the cyst, a 70-cm Roux limb was measured and the jejunum divided. A retrocolic tunnel was created to the right of the middle colic artery and the Roux limb was delivered into the subhepatic space. A single-layer hepaticojejunostomy was fashioned with a continuous 3/0 absorbable monofilament suture. Completion cholecystectomy was performed. The mesenteric defect was closed and a stapled jejuno-jejunostomy was fashioned to complete the operation. The patient made an uneventful recovery and was discharged home on the fourth postoperative day. Histology of the choledochal cyst confirmed no evidence of dysplasia or malignancy. Our video demonstrates a safe technique for the laparoscopic treatment of choledochal cystic disease.
No competing financial interests exist.
Runtime of video: 9 mins 30 secs
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