Gadiyaram Srikanth, MCh, Neel Shetty, MCh, Ganesh Shenoy. Institute of Gastroenterology, Global Hospitals, Bangalore.
Background : Complete excision of the extrahepatic biliary apparatus with bilio-enteric reconstruction is the procedure of choice for a choledochal cyst. Few centers have reported the feasibility of using the laparoscopic approach for excision and reconstruction. Using the laparoscopic procedure in a patient who has undergone an earlier biliary drainage procedure can be technically challenging.
Case Report: A 58 year old gentleman presented to us with history of repeated episodes of cholangitis. He had undergone an open cholecystectomy , common bile duct (CBD) exploration and choledochoduodenostomy 8 months ago following a failed attempt of endoscopic CBD clearance for choledocholitiasis .On evaluation magnetic resonance cholangio-pancreaticography showed features of Type I Choledochal cyst . He underwent 5 port laparoscopic excision of the Choledochal cyst in the following steps . Step 1 – Adhesiolysis , delination and dismantling of previous choledochoduodenostomy ; Step 2 -Excision -of Choledochal cyst; Step 3 – Roux –en –Y hepatico jejunostomy . The duration of surgery was 4 hours and intra-operative blood loss was 100ml. The patient enjoyed a uneventful post operative stay and was discharged on the 4th post operative day. On follow up LFT, HIDA scan and USG abdomen were normal.
Conclusion: Laparoscopic excision of choledochal cyst in the presence of prior biliary drainage procedure is feasible but requires the advanced endo-suturing skills.