Sumita A Jain, Senior Professor. SMS Hospital and Medical College
Choledochal cysts (CCs) are rare medical conditions with an incidence in the western population of 1 in 100 000–150 000 live births.
50%–80% are type I, 2% type II, 1.4%–4.5% type III, 15%–35% type IV 20% type V.
The etiology of CCs is still unclear. Babbitt’s theory of cysts caused by an abnormal pancreaticobiliary duct junction (APBDJ) such that the pancreatic duct and the common bile duct meet outside the ampulla of Vater, thus forming a long common channel, has gained much popularity.
CC is a premalignant state. The overall risk of cancer has been reported to be 10%–15%, and increases with age.
MRCP is currently the most accurate preoperative imaging study to assess cyst anatomy and classify the disease according to standard Todani classification
The treatment of choice for choledochal cysts is complete excision with construction of a biliary-enteric anastomosis to restore continuity with the gastrointestinal tract.
Type I: is complete excision of the involved portion of the extrahepatic bile duct; & Roux-en-Y hepaticojejunostomy
Type II: Complete excision of the dilated diverticulum comprising a type II choledochal cyst; the resultant defect in the common bile duct is closed over a T-tube
Type III (choledochocele): 3 cm or less can be treated with endoscopic sphincterotomy, >3 cm are excised surgically via a transduodenal approach.
Type IV: Complete excision of dilated duct followed by a Roux-en-Y hepaticojejunostomy.
Type V (Caroli disease): One lobe-Hepatic Lobectomy, Bilobar-Liver transplantation.
We present a 17 year old girl who had type 2 (saccular) choledochal cyst which is very rare and that’s why Very few cases of laparoscopic management of type 2 choledochal cyst has been reported in the literature. We managed this case by laparoscopic excision of choledchal cyst in its entirety and closure of defect.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94919
Program Number: P234
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster