Abstract
Background:
Choledochal cysts are congenital dilations of the biliary system, either intrahepatic, extrahepatic, or both. They are sometimes associated with variations in biliary anatomy. The current standard in management of choledochal cysts is surgical resection of the cyst(s) with biliary–enteric anastomosis. 1,2 This video shows standard laparoscopic choledochal cyst resection and the surgical management of variations in biliary anatomy seen during laparoscopic choledochal cyst resections.
Patients and Methods:
In this video, we show laparoscopic resections of three patients' extrahepatic choledochal cysts. Their ages are 6 months, 1 year, and 3 years, respectively. Preoperative magnetic resistance cholangiopancreatography was completed for surgical planning before resection. Under general anesthesia, four laparoscopic ports were placed. One camera port (5/10 mm), two working ports (5 mm), and one for liver retraction (5 mm). Placement of the ports was almost similar to those for a laparoscopic cholecystectomy. One patient had standard choledochal cyst anatomy and underwent a laparoscopic choledocal cyst excision and hepaticoduodenostomy. The second patient had a trifurcation anomaly at the hilum. For this, we first approximated the three separate ducts together into a common sheath. A hepaticoduodenostomy was then completed by anastomosing the common sheath to the first part of the duodenum. The third patient had an accessory bile duct in the gallbladder fossa observed during removal of the cyst, for which a Roux-en-Y hepaticojejunostomy of both the common hepatic duct and the accessory bile duct was completed. At 1 year follow-up, all three patients were asymptomatic, with normal bilirubin, normal stools, and no episodes of cholangitis.
Conclusions:
Uncommon variations in anatomy can be seen in children with choledochal cysts. This video shows different technical options for laparoscopic management of these anatomical variations when discovered during choledochal cyst excision.
Runtime of video: 10 mins
Keywords
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