Laparoscopic excision of choledochal cyst with hepaticojejunostomy

Abstract

Choledochal cyst is a common congenital biliary tract anomaly. The standard treatment of type I choledochal cyst is complete cyst excision followed by hepaticoenterostomy (Lilly 1979; Miyano et al. 1996). This minimises the risks of associated complications including biliary strictures, calculus, recurrent cholangitis and bile duct malignancy that were once prevalent when choledochal cysts were managed by internal bypass surgery without cyst excision (Todani et al. 1987). The classical approach for cyst excision and biliary reconstruction entails a laparotomy usually through a long upper abdominal transverse incision to achieve adequate surgical exposure and space for operative manipulation. This is however associated with significant postoperative pain and hence analgesia requirement, often prolonged paralytic ileus and unsightly abdominal scars. There are recent anecdotal reports of a laparoscopic approach for choledochal cysts in adults. Besides the usual benefits of minimal access surgery, a laparoscopic approach offers additional potential advantages of providing an excellently illuminated and magnified view of the porta hepatis, thereby greatly facilitating meticulous dissection of the portal structures and the subsequent hepaticoenterostomy anastomosis. We describe our technique of laparoscopic excision of choledochal cyst with hepaticoenterostomy in infants and young children. © Springer-Verlag Berlin Heidelberg 2008.