Page 33 - World Journal of Laparoscopic Surgery

Laparoscopic Choledochal Cyst Resection with Biliary Reconstruction

Fig. 5: Laparoscopic hepaticojejunostomy Fig. 6: Lateral–lateral omega jejunojejunostomy

Table 2: Patient referral characteristics with bile duct injury
Variable Sub n = 10 (%)
Age (years, median, SD) 34.5
Gender Female 100
Male 0
Choledochal cyst type IA 75
IVB 25
ASA classification ASA 1/2 100
ASA 3/4 0
Patients with preoperative ERCP or Yes 100
CPRMN No
ASA, the American Society of Anesthesiologists physical status classifica-
tion

our center. Patients demographics are presented in Table 2. All
Fig. 7: Simplified hepaticojejunostomy in Roux-en-Y patients were women, 75% of them presented Todani type I CC
and 25% Todani IV-B, without other associated malformations.
Please refer to the online video material: Choledochal cyst About 50% of them were diagnosed during endoscopic retrograde
69556 Bestoun Ahmed (this material was presented at SAGES annual cholangiopancreatography (ERCP) and other 50% with a magnetic
meeting, Baltimore, 2019). resonance imaging (MRI). All of them were taken to resection of the
common bile duct with a Roux-en-Y hepaticojejunostomy.
Postoperative Care
The operative time was approximately 147 minutes. The patient Surgical Outcomes
ambulated on the same day of the procedure and tolerated oral Average surgery time was 147 minutes; and the average
food intake. The peritoneal drain was removed on postoperative intraoperative bleeding was 15 cc. No intra or postoperative
day 2; and all the patients were discharged the following day. No complications were detected. There were no operative site
patients required ICU or reintervention. infections, biliary leaks, and no mortality. The mean hospital stay
time was 5 days.
One patient required ICU admission for 2 days due to

stAtIstIcAl AnAlysIs anesthetic complications. There was no need for open conversion
Being an observational retrospective cohort, a descriptive of the procedures and all patients had oral feeding and adequate
analysis of the data was performed prospectively in Microsoft tolerance at 1 day postoperative. Long-term follow-up showed no
Excel databases and analyzed using SPSS1 (Statistical Package for bile reflux at 2 years following surgery (Table 3).
The Social Sciences) V.22.0. Variables were analyzed and median,
minimum, maximum values, and percentages were obtained. dIscussIon
results In 1723, Vater and Ezler described for the first time, the CC; however,
it was not until 1977 that Todani described the classification that it
Patient Characteristics is most frequently used nowadays (Fig. 1). 4,5,8,9 The management of
Between 2013 and 2018, 10 patients with a diagnosis of CC this pathology has evolved from a cysto-enterostomy to advanced
underwent simplified laparoscopic bile duct reconstruction in bilioenteric reconstructions with Roux-en-Y configuration. 3,10

World Journal of Laparoscopic Surgery, Volume 12 Issue 2 (May–August 2019) 79