C Palanivelu, MS, MCh, FACS, P Senthilnathan, MS, FACS, R Parthasarathi, MS, P Praveen Raj, MS, S Rajapandian, MS, R Sridhar, MS. GEM Hospital & Research Centre, Coimbatore, INDIA.
Choledochal cyst is anomaly of the biliary system manifested by cystic dilatation of the extra or intra hepatic biliary tree or both. The accepted mode of treatment is total excision with hepaticojejunostomy or hepaticoduodenostomy. Laparoscopic excision of choledochal cysts can be safely accomplished with acceptable morbidity and allows prompt recovery. Here we present a video depicting the technical details of this procedure.
The patient is placed in supine position with port position and team setup are similar to laparoscopic cholecystectomy. We place four ports for the procedure. We begin our dissection with the mobilization of duodenum and head of pancreas from the cyst. Dissecting posterior cyst wall from the underlying portal vein is the most crucial part of the procedure. In order to minimize risk of malignancy, total excision of the cyst is done. Distal end of the cyst is clipped and divided taking care to avoid injury to the pancreatic duct. Similarly, proximal part is divide above the cyst. Reconstruction was done by hepatico duodenostomy in a single layer interrupted sutures.
Laparoscopic surgery for choledochal cysts is feasible, safe and even advantageous, as it provides a magnified view.