Page 30 - World Journal of Laparoscopic Surgery

CASE REPORT
Laparoscopic Choledochal Cyst Resection with Simplified

Common Bile Duct Reconstruction in an Adult Population:

A Case Series

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Daniel Gomez , Luis F Cabrera , Mauricio Pedraza , Sebastian Sanchez , Jean A Pulido , Ricardo Villarreal ,
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Andres C Mendoza , Daniela Moreno , Natan Zundel 9
AbstrAct
Introduction: Choledochal cysts (CC) are rare congenital pathology in adult population. Since 1995, laparoscopic management has been
described for this entity. Nevertheless, its management is considered to be a controversial matter due to the augmented risk of associated
cholangiocarcinoma.
Materials and methods: A retrospective, observational, and descriptive study was conducted considering patients diagnosed with CC who
were operated at a hepatobiliary surgery referral center from January 2013 to June 2018. Patients were taken to simplified laparoscopic
hepaticojejunostomy with a Roux-en-Y reconstruction. A retrospective analysis of the data obtained is presented.
Results: Ten adult patients with CC underwent surgical biliary reconstruction at a mean age of 34.5 years; 75% had Todani type I CC and 25%
Todani type IV-B CC. About 50% of the patients were diagnosed via endoscopic retrograde cholangiopancreatography (ERCP) and 50% of them
via magnetic resonance cholangiopancreatography. None required re-intervention, no mortality was reported; and the mean hospital stay was
5 days, no patient had postoperative biliary leakage, none was converted to open surgery, and all patients had adequate oral feeding tolerance
2 days postoperative. Long-term follow-up showed no incidence of cholangiocarcinoma after 2-year follow-up.
Conclusion: Choledochal cysts in adults is a rare pathology that has a high probability of developing malignancy when not adequately surgically
managed and because of secondary bile reflux. These factors make surgical management a critical decision. The simplified laparoscopic approach
presented in this paper seems to be an effective and safe alternative to biliary duct reconstructive surgery.
Keywords: Biliary duct surgery, Biliary reconstruction, Choledochal cyst, Laparoscopic approach.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1366

IntroductIon

Choledochal cysts are congenital dilatations of the intrahepatic 1 Department of Advanced Laparoscopic Surgery, Universidad Militar
or extrahepatic biliary ducts. 1–5 They are associated with the Central, Bogotá, Colombia
development of cholangiocarcinoma. Their incidence predominates 2 Department of General Surgery, Universidad El Bosque, Bogotá,
in eastern population where it is reported to be approximately Colombia; Department of General Surgery, Fundacion Santa Fe de
0.00769% higher than western population where the incidence is Bogotá, Bogotá, Colombia
around 0.000666%. These are estimated numbers; the real incidence of 3,5,7,8 Department of General Surgery, Universidad El Bosque, Bogotá,
CCs in adult population has not been established so far, since in most Colombia
cases they are incidentally diagnosed on images or during surgery. 1,2,6 4 Department of General Surgery, Pontificia Universidad Javeriana,
The first case of laparoscopic approach for CC resection was Bogotá, Colombia
published by Farello et al. in 1995, since then, different studies have 6
Department of General Surgery, Universidad El Bosque, Bogotá,
shown that minimally invasive techniques can reduce surgical time, Colombia; Department of Gastrointestinal Surgery, Los Cobos Medical
postoperative morbidity, postoperative pain control, and incidence Center, Bogotá, Colombia
of surgical site infections (SSI). Better results with laparoscopy 9
are reported on patients who have CC Todani type I, II, and IVb FIU Herbert Wertheim College of Medicine, Miami, Florida, USA;
compared with the results with open approaches. 2,6,7 Minimally Invasive and Bariatric Surgery, Fundacion Santa Fe de Bogota
University Hospital, Bogotá, Colombia
We present our experience with laparoscopic CC resection and
simplified bile duct reconstruction in an adult population, analyzing Corresponding Author: Mauricio Pedraza, Department of General
the technical aspects of a novel procedure, postoperative clinical Surgery, Universidad El Bosque, Bogotá, Colombia, Phone: +57
301370957, e-mail: mpedraza93@gmail.com
evolution of the patients involved in the study, and the incidence
of cholangiocarcinoma in a 2-year postoperative follow-up. How to cite this article: Gomez D, Cabrera LF, Pedraza M, et al.
Laparoscopic Choledochal Cyst Resection with Simplified Common
MAterIAls And Methods Bile Duct Reconstruction in an Adult Population: A Case Series. World J

Lap Surg 2019;12(2):76–82.
Design Source of support: Nil

We conducted a retrospective, observational, and descriptive study Conflict of interest: None
with a population of 10 adult patients diagnosed with CC who

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