Daniel Gomez, MD, FACS1, Luis F Cabrera, MD, General Surgeon2, Andres Mendoza, MD, General Surgeon2, Ricardo Villarreal, MD2, Mauricio Pedraza2, Jean Pulido2, Eric E Vinck, MD2, Sebastian Sanchez2. 1CPO, 2Bosque University
Introduction: Common bile duct cysts are infrequent pathologic anomalies of the biliary system. When present they cause significant signs and symptoms ranging from abdominal pain to cholangitis. All CBD cyst are potentially malignant with a risk of developing malignancy of up to 30%, therefore surgical resection is imperative in the treatment arsenal especially type I and IV.
Objective: Describe a minimally invasive approach to common bile duct cyst and detailing aspects of cystic resections in laparoscopic surgery.
Methods: We present a case of a 35-year old female patient presenting with a type IA CBD cyst. The patient is taken to a laparoscopic cyst resection along with a biliary reconstruction. This approach involved broad dissection around the CBD exposing all biliary structures as well as the cyst. After removing damaged and inflamed tissue and providing an adequate view of the entire cyst, resection was performed using a linear mechanical suture for the CBD and sharp dissection to cut the hepatic duct. A biliary reconstruction is performed using a Roux in Y technique, and the gallbladder is removed along with the cyst in a block extraction style.
Results: Surgery time was 146 minutes, intra-operative bleeding was 15cc and total hospital stay was 4 days. The patient had a complete laparoscopic procedure with no need for ICU admission, no bile leaks were reported or other complications in the postoperative days. Oral intake at post operatory day 1. Five-year follow-up showed no signs of biliary strictures.
Conclusions: CBD cyst are complicated pathologies with a high malignancy risk and laparoscopic approach is becoming a standard of treatment for type I and IV cysts. The technicalities of laparoscopic bile duct cystic surgery put a great demand on the surgeon, thus laparoscopic resections should always be considered if the equipment is available and inexperienced hands. Minimally invasive approaches can be a safe and effective treatment option for these pathologies.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95822
Program Number: V315
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop