Laparoscopic Management of Choledochal Cysts Associated with Aberrant Hepatic Ducts

Abstract

Introduction and objectives: This study assessed the diagnostic protocol and the outcomes of laparoscopic aberrant hepatic duct (AHD) reconstruction in choledochal cyst (CC) surgery. Methods: From January 2010 to January 2018, 275 laparoscopic CC excisions were conducted in our hospital. Seven patients of CC with associated AHD were recorded. AHDs that drained into the cystic duct were anastomosed to the Roux-en-Y loop. Clinical data of these 7 patients were retrospectively analyzed. Results: AHD is classified into four types according to the literature. The type where AHD drains into the cystic duct is the most commonly encountered one. The incidence of this type was 2.5% (7/275) in our series. Preoperative examination included magnetic resonance cholangiopancreatography (MRCP) (5 patients) and computed tomography (CT) scan (2 patients). Suspected AHD was diagnosed preoperatively in 4 out of the 5 patients who underwent MRCP. For the 2 patients who underwent CT scan only, AHD was not detected preoperatively. AHD was verified intraoperatively for all the 4 patients who had suspected diagnosis. Among them, AHD was well preserved in 3 patients, but damaged at exploration in the remaining 1. For the remaining 3 patients without preoperative AHD diagnosis, bile leakage was detected intraoperatively. Ductoplasty of the AHD with common hepatic duct was performed in 3 patients, and AHD was incorporated into the Roux-en-Y jejunal loop separately in 4 patients. Laparoscopic surgical procedures were completed in 6 of the 7 patients in this study, while 1 patient was converted into an open procedure. Postoperative recovery was uneventful in all patients. The duration of follow-up ranged from 6 months to 4 years (median 2 years) with no complication encountered. Conclusions: Routine preoperative MRCP examination of CC is recommended to detect variations of biliary tree. The laparoscopic approach is a feasible option in the experienced hands.