World Journal of Laparoscopic Surgery

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VOLUME 12 , ISSUE 2 ( May-August, 2019 ) > List of Articles

CASE REPORT

Laparoscopic Choledochal Cyst Resection with Simplified Common Bile Duct Reconstruction in an Adult Population: A Case Series

Daniel Gomez, Jean A Pulido, Ricardo Villarreal, Andres C Mendoza, Daniela Moreno, Natan Zundel

Keywords : Biliary duct surgery, Biliary reconstruction, Choledochal cyst, Laparoscopic approach

Citation Information : Gomez D, Pulido JA, Villarreal R, Mendoza AC, Moreno D, Zundel N. Laparoscopic Choledochal Cyst Resection with Simplified Common Bile Duct Reconstruction in an Adult Population: A Case Series. World J Lap Surg 2019; 12 (2):76-82.

DOI: 10.5005/jp-journals-10033-1366

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Choledochal cysts (CC) are rare congenital pathology in adult population. Since 1995, laparoscopic management has been described for this entity. Nevertheless, its management is considered to be a controversial matter due to the augmented risk of associated cholangiocarcinoma. Materials and methods: A retrospective, observational, and descriptive study was conducted considering patients diagnosed with CC who were operated at a hepatobiliary surgery referral center from January 2013 to June 2018. Patients were taken to simplified laparoscopic hepaticojejunostomy with a Roux-en-Y reconstruction. A retrospective analysis of the data obtained is presented. Results: Ten adult patients with CC underwent surgical biliary reconstruction at a mean age of 34.5 years; 75% had Todani type I CC and 25% Todani type IV-B CC. About 50% of the patients were diagnosed via endoscopic retrograde cholangiopancreatography (ERCP) and 50% of them via magnetic resonance cholangiopancreatography. None required re-intervention, no mortality was reported; and the mean hospital stay was 5 days, no patient had postoperative biliary leakage, none was converted to open surgery, and all patients had adequate oral feeding tolerance 2 days postoperative. Long-term follow-up showed no incidence of cholangiocarcinoma after 2-year follow-up. Conclusion: Choledochal cysts in adults is a rare pathology that has a high probability of developing malignancy when not adequately surgically managed and because of secondary bile reflux. These factors make surgical management a critical decision. The simplified laparoscopic approach presented in this paper seems to be an effective and safe alternative to biliary duct reconstructive surgery.


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  1. Soares KC, Arnaoutakis DJ, Kamel I, et al. Choledochal cysts: presentation, clinical differentiation, and management. J Am Coll Surg 2014;219(6):1167–1180. DOI: 10.1016/j.jamcollsurg.2014.04.023.
  2. Hasan A, Nuha Y, Basil A. Laparoscopic resection of type I choledochal cyst in an adult and Roux-en-Y hepaticojejunostomy: a case report and literature review. Surg Laparosc Endosc Percutan Tech 2006;16(6):439–444. DOI: 10.1097/01.sle.0000213768.70923.99.
  3. Palanivelu C, Rangarajan M, Parthasarathi R, et al. Laparoscopic management of choledochal cysts: technique and outcomes – a retrospective study of 35 patients from a tertiary center. J Am Coll Surg 2008;207(6):839–846. DOI: 10.1016/j.jamcollsurg.2008.08.004.
  4. Edil BH, Olino K, Cameron JL. The current management of choledochal cysts. Adv Surg 2009;43:221–232. DOI: 10.1016/j.yasu.2009.02.007.
  5. Tadokoro H, Takase M. Recent advances in choledochal cysts. OJ Gas 2012;2(4):145–154. DOI: 10.4236/ojgas.2012.24029.
  6. Ahmed B, Sharma P, Leaphart CL. Laparoscopic resection of choledochal cyst with Roux-en-Y hepaticojejunostomy: a case report and review of the literature. Surg Endosc 2017;31(8):3370–3375. DOI: 10.1007/s00464-016-5346-3.
  7. Crespo G, Garcia M, Marqués E, et al. Lesiones quísticas del conducto cístico (lesiones tipo VI). Rev Esp Enferm Dig 2017;109(5):373.
  8. Soares KC, Goldstein SD, Ghaseb MA, et al. Pediatric choledochal cysts: diagnosis and current management. Pediatr Surg Int 2017;33(6): 637–650. DOI: 10.1007/s00383-017-4083-6.
  9. Manoj Kumar GP, Rajagopalan B. Choledochal cyst. Med J Armed Forces India 2012;68(3):296–298. DOI: 10.1016/j.mjafi.2012.04.011.
  10. Wang S-E, Chen S-C, Shyr B-U, et al. Robotic assisted excision of type I choledochal cyst with Roux-en-Y hepaticojejunostomy reconstruction. Hepatobiliary Surg Nutr 2017;6(6):397–400. DOI: 10.21037/hbsn.2017.01.15.
  11. Stringer M. Laparoscopic management of choledochal cysts: is a keyhole view missing the big picture? Pediatr Serg Int 2017;33(6): 651–655. DOI: 10.1007/s00383-017-4089-0.
  12. Sastry AV, Abbadessa B, Wayne MG, et al. What is the incidence of biliary carcinoma in choledochal cysts, when do they develop, and how should it affect management? World J Surg 2015;39(2):487–492. DOI: 10.1007/s00268-014-2831-5.
  13. Chaturvedi A, Singh J, Rastogi V. Case report: cholangiocarcinoma in a choledochal cyst. Indian J Radiology & Imaging 2008;18(3):236–238. DOI: 10.4103/0971-3026.41836.
  14. Congo K, Lopes MF, Oliveira PH, et al. Outcomes of choledochal cysts with or without intrahepatic involvement in children after extrahepatic cyst excision and Roux en Y hepaticojejunostomy. Ann Hepatol 2012;11(4):536–543. DOI: 10.1016/S1665-2681(19)31468-1.
  15. Shimamura K, Kurosaki I, Sato D, et al. Intrahepatic cholangiocarcinoma arising 34 years after excision of a type IV – a congenital choledochal cyst: report of a case. Surg Today 2009;39(3):247–251.
  16. Tang Y, Li F, He G. Comparison of single-incision and conventional laparoscopic cyst excision and Roux en Y hepaticojejunostomy for children with choledochal cyst. Indian J Surg 2016;78(4):259–264. DOI: 10.1007/s12262-015-1348-y.
  17. Urushihara N, Fukumoto K, Fukuzawa H, et al. Hepaticojejunostomy and intrahepatic cystojejunostomy for type IV – A choledochal cyst. J Pediatr Surg 2007;42(10):1753–1756. DOI: 10.1016/j.jpedsurg. 2007.06.012.
  18. Lee H, Hirose S, Bratton B, et al. Initial experience with complex laparoscopic biliary surgery in children: biliary atresia and choledochal cyst. J Pediatr Surg 2004;39(6):804–807. DOI: 10.1016/j.jpedsurg.2004.02.018; discussion 804-7.
  19. Narayanan SK, Chen Y, Narasimhan KL, et al. Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: a systematic review and meta-analysis. J Pediatr Surg 2013;48(11): 2336–2342. DOI: 10.1016/j.jpedsurg.2013.07.020.
  20. Madadi-Sanjani O, Petersen C, Ure B. Minimally invasive hepatobiliary surgery. Clin Perinatol 2017;44(4):805–818. DOI: 10.1016/j.clp. 2017.08.004.
  21. Madadi-Sanjani O, Wirth TC, Kuebler JF, et al. Choledochal cyst and malignancy: a plea for lifelong follow-up. Eur J Pediatr Surg 2017;29(2):143–149. DOI: 10.1055/s-0037-1615275.
  22. Drabek J, Keil R, Stovicek J, et al. The role of endoscopic retrograde cholangiopancreatography in choledochal cysts and/or abnormal pancreatobiliary junction in children. Prz Gastroenterol 2017;12(4):303–309. DOI: 10.5114/pg.2017.72107.
  23. Ten Hove A, de Meijer VE, Hulscher JBF, et al. Meta-analysis of risk of developing malignancy in congenital choledochal malformation. Br J Surg 2018;105(5):482–490. DOI: 10.1002/bjs.10798.
  24. Lal R, Agarwal S, Shivhare R, et al. Type IV-a choledochal cysts: a challenge. J Hepatobiliary Pancreat Surg 2005;12(2):129–134. DOI: 10.1007/s00534-004-0960-1.
  25. Banks JS, Saigal G, D'Alonzo JM, et al. Choledochal malformations: surgical implications of radiologic findings. AJR Am J Roentgenol 2018;210(4):748–760. DOI: 10.2214/AJR.17.18402.
  26. Katabi N, Pillarisetty VG, DeMatteo R, et al. Choledochal cysts: a clinicopathologic study of 36 cases with emphasis on the morphologic and the immunohistochemical features of premalignant and malignant alterations. Hum Pathol 2014;45(10):2107–2114. DOI: 10.1016/j.humpath.2014.06.016.
  27. Nicholl M, Pitt HA, Wolf P, et al. Choledochal cysts in western adults: complexities compared to children. J Gastrointest Surg 2004;8(3): 245–252. DOI: 10.1016/j.gassur.2003.12.013.
  28. Ong J, Campbell W, Taylor MA. Metastatic cholangiocarcinoma following choledochal cyst excision: an unusual cause of abdominal pain in a 35-year-old female. Ulster Medical Journal 2013;82(1):21–22.
  29. Voyles CR, Smadja C, Shands WC, et al. Carcinoma in choledochal cysts. Age-related incidence. Arch Surg 1983;118(8):986–988. DOI: 10.1001/archsurg.1983.01390080088022.
  30. Kobayashi S, Asano T, Yamasaki M, et al. Risk of bile duct carcinogenesis after excision of extrahepatic bile ducts in pancreaticobiliary maljunction. Surgery 1999;126(5):939–944. DOI: 10.1016/S0039- 6060(99)70036-X.
  31. He XD, Wang L, Liu W, et al. The risk of carcinogenesis in congenital choledochal cyst patients: An analysis of 214 cases. Annals of Hepatology 2014;13(6):819–826. DOI: 10.1016/S1665-2681(19)30985-8.
  32. Lee SE, Jang JY, Lee YJ, et al. Choledochal cyst and associated malignant tumors in adults: a multicenter survey in South Korea. Arch Surg 2011;146(10):1178–1184. DOI: 10.1001/archsurg.2011.243.
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