Abstract
The method of choice for the treatment of choledochal cysts in children is excision of the cyst and Roux-en-Y (RY) choledochoenterostomy. When the ratio of the diameter of the main hepatic ductus to that of the proximal RY jejunum is 1:2.5 or lower during choledochoenterostomy, end-to-end anastomosis is recommended. However, this method may cause a difference in diameters between the ends. Here we will present the technical difficulty we experienced due to the difference in diameters in end-to-end RY choledochoenterostomy and our modified anastomosis technique of anas¬tomosis. This slight modification eliminated problems with anastomosis caused by a difference in the diameter of the jejunum and shortened operation time.
Highlights
IntroductionIf end-to-side anastomosis is inevitable, it should be performed on the most distal end of the blind jejunal pouch possible [2]
When the ratio of the diameter of the main hepatic ductus to that of the proximal RY jejunum is 1:2.5 or lower during choledochoenterostomy, end-to-end anastomosis is recommended
When MR (Magnetic Resonance) cholangiography confirmed that the patient had a choledochal cyst containing multiple stones, we decided to operate on the patient
Summary
If end-to-side anastomosis is inevitable, it should be performed on the most distal end of the blind jejunal pouch possible [2]. Blind jejunal pouch can get longer when end-to-side anastomosis is performed and this can cause bile stasis, which may result in bile stone formation in intrahepatic bile ducts, pancreatitis and cholangitis [1,3]. This method may cause a difference in diameters between the ends. Direct abdominal x-ray taken when the patient was standing showed two air-fluid levels on the posterior upper quadrant and USG demonstrated a choledochal cyst containing multiple calculi. When MR (Magnetic Resonance) cholangiography confirmed that the patient had a choledochal cyst containing multiple stones, we decided to operate on the patient
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