Srikanth Gadiyaram, Dr, Gaurav Singh, Dr, Yashas H Ramegowda, Dr. Sahasra Hospitals, Centre of Excellence for Gastroenterology, Bangalore, India
Background: Laparoscopic excision of the extrahepatic biliary apparatus with bilio-enteric reconstruction has become standard of care for type 1 choledochal cyst in many centres world wide. Revisional surgery done laparoscopically for excising a choledochal cyst following a cysto-enterostomy could be challenging, Herein is an operative video demonstrating the steps of the procedure.
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. At a followup of six years patient remains asymptomatic with normal liver function tests.
Conclusion: Laparoscopic excision of choledochal cyst in the presence of prior biliary drainage procedure is challenging, yet safe and feasible. Laparoscopic hepaticojejunostomy requires advanced endosuturing skills.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95284
Program Number: V039
Presentation Session: Exhibit Hall Theater Video Session I
Presentation Type: EHVideo