Ajay H Bhandarwar, MS, FMAS, FIAGES, FAIS, FICS, FBMS, FLCS1, Ravindra Ramadwar, MS, MCH, DNB, FRCS, Paed, surgery2, Nidhisha Sadhwani, MBBS1, Shivang D Shukla, MBBS3, Amol Wagh, MS, FAIS, FMAS, FBMS, FALS, FIAGES, FICS1, Eham Arora, MSDNB1, Shekhar Jadhav, MS, FMAS1, Amarjeet Tandur, MS1. 1Grant Government Medical College & Sir J.J. Group of Hospitals, Mumbai, India, 2Bombay Hospital, 3Grant Govt. Medical College & Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India
Adult Choledochal cysts are a rare entity, with only upto 20% cases presenting in the adulthood.
Ideal treatment is cyst excision with hepatico-enterostomy which has increasingly been performed laparoscopically in the last 5 years.
Adults almost always present with complications. The cyst in the video was a longstanding one with dense adhesions between the posterior wall and the portal vein. Also, intra-operatively, an anomalous right hepatic artery was discovered. The adhesions and the replaced right hepatic artery precluded safe pericystic dissection. Thus, we decided to adopt the technique of mucosectomy published by Lilly as shown in the video.
Looking at the pros and based on our experience with laparoscopic Hepatico-Duodenostomy, it was our preferred technique of reconstruction.
Literature about laparoscopic surgery in such a presentation in adults is limited.
This video highights endoscopic management of an adult coledochal cyst with a right hepatic artery anomaly, key steps and critical aspects of the dissection are depicted in the video.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93648
Program Number: V035
Presentation Session: Exhibit Hall Theater Video Session I
Presentation Type: EHVideo