Sarrath Sutthipong, MD, Panot Yimcharoen, MD, Poschong Suesat, MD. Bhumibol Adulyadej Hospital
Background: Choledochal cyst (CC) is a rare disease, characterized by dilatations of the extra- or/and intrahepatic bile ducts. CCs occur most frequently in Asian and female populations. CC is associated with biliary lithiasis and considered at risk of malignant transformation. Todani’s classification dividing CC into 5 types is the most useful in clinical practice. The current standard treatment is complete cyst excision with Roux-en-Y hepaticojejunostomy and cholecystectomy for the extrahepatic disease (Todani type I and IV). In this report we present our experience using a total laparoscopic technique to treat adult patients with CC in 5-year period.
Methods: A retrospective review of the records of the patients above 15 years who underwent laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy in our hospital between January 2013 and May 2017 was carried out. The data included the clinical presentation, investigation, perioperative details and complication. The type of CC was classified according to Todani’s classification.
Results: Seven cases of CC were reviewed, 6 females and 1 male with mean age 33 years (range 20 – 65 years). These included 5 cases of Todani type IB and 2 cases of type 4A. The predominant symptoms were chronic abdominal pain and jaundice. A case of both pancreatitis and cholangitis were also seen. Investigations included ultrasound with MRCP in 6 cases and ERCP in 1 case. The mean operative time was 4 hours and 20 minutes (3 hours 30 minutes to 5 hours range) with mean intraoperative blood loss 85 ml (range 20 – 200 ml). All the resected specimens showed chronic inflammation. Malignancy was not seen in any patients. The early postoperative complications included bile leakage with intra-abdominal collection in 2 patients, which were managed conservatively (evidenced by clinical status and imaging study), re-operation was not required. The median duration of hospital stay was 8 days (range 6 – 23 days). There was no perioperative mortality. All patients were followed up at 1, 6, and 12 months postoperatively, late complication were not detected during each visit.
Conclusion: In our opinion, laparoscopic cyst excision and hepaticojejunostomy could offer more feasible and safe methods of treatment for CCs in adult patients with potentially less postoperative morbidity, a shortened length of stay and a lower blood loss when compared to the preferred open approach. However, we would need to study this on a larger sample of patients to report the efficacy and safety of laparoscopic approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86380
Program Number: P101
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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