Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults

Summary

Choledochal cysts in adults are relatively rare, and few reports have detailed treatment options. Here, we present a case demonstrating laparoscopic resection of choledochal cysts and posterior colonic Roux-en-Y choledochojejunostomy in adults, offering an alternative for clinical management.

Abstract

Choledochal cysts (CCs), known as congenital choledochal dilatations, are more prevalent in Asia. The majority of patients with abdominal symptoms are diagnosed and treated during early childhood, which results in a lower prevalence of CCs in adults. The treatment of choice for CCs is complete cyst excision followed by choledochojejunostomy. Laparoscopic surgery is now more widely accepted than traditional open surgery due to its smaller incisions, faster recovery, and less postoperative pain. However, there are few reports on laparoscopic excision of CCs in adults. This article presents a protocol that describes and demonstrates the complete procedure for laparoscopic excision of a choledochal cyst and Roux-en-Y choledochojejunostomy. A 32-year-old woman diagnosed with a 2.5 cm by 3 cm CC underwent surgery using a laparoscopic approach with post-colonic anastomosis. The procedure lasted 290 min with an estimated blood loss of approximately 100 mL. A follow-up abdominal CT scan on the sixth postoperative day showed a satisfactory recovery, leading to her discharge on the ninth day. This study aims to demonstrate the feasibility and safety of laparoscopically assisted excision of CCs in adults. This procedure is expected to become the preferred surgical option for CCs in adults due to its minimal surgical trauma and rapid postoperative recovery.

Introduction

Choledochal cysts (CCs), also known as congenital choledochal dilatations, can be single or multiple and involve the intrahepatic or extrahepatic bile ducts. These cysts are most commonly found in Asia, where the incidence is approximately 100 times higher than in Europe and the United States, affecting about 1 in 1,000 individuals¹. CCs are most commonly diagnosed in children². However, the number of adult patients diagnosed with CCs has increased in recent years, particularly among young females, who are affected at a rate four times higher than males³. The etiology of CCs remains unclear, but i....

Protocol

The study protocol was conducted in accordance with the Ethics Committee of Shenzhen People's Hospital, Second Medical College of Jinan University. Written informed consent was obtained from the patients for this study and the subsequent surgery.

NOTE: A 36-year-old female patient presented with intermittent epigastric pain and was diagnosed with a choledochal cyst (CC), type I choledochal dilatation, using Magnetic Resonance cholangiopancreatography (MRCP). No stones or other obstructions in the bile ducts were observed.

1. Preoperative workup

1. Determine the cyst's location, s....

Discussion

Choledochal cysts are prone to complications such as cholangitis, which can cause recurrent abdominal pain, jaundice, and fever; repeated inflammation may even lead to malignant transformations. Therefore, early diagnosis and complete cyst removal are necessary¹⁴. Abdominal ultrasound should be the first option when a choledochal cyst (CC) is suspected. If the ultrasound shows abnormal echoes in the area of the common bile duct, further imaging is warranted. Computed tomography (CT) is an importan.......

Materials

Name	Company	Catalog Number	Comments
5-0 Polydioxanone sutures	Ethicon Medical Technology Co.	W9733T
Articulating Endoscopic Linear Cutter	Jinhuawai Medical Technology Co.	HWQM60A
Harmonic	Ethicon Medical Technology Co.	HAR36
High frequency ablation of hemostatic electrodes	Shuyou Medical Equipment Co.	sy-vIIc(Q)-5
Ligature clips	Wedu Medical Equipment Co.	WD-JZ(S)
Ligature clips	Wedu Medical Equipment Co.	WD-JZ(M)
Linear Cutter universal loading unit	Jinhuawai Medical Technology Co.	HWQM60K
Two-electrode voltage-clamp	Karl Storz Se & Co.	38651ON