Management of Type I Choledochal Cyst in Adult: Totally Laparoscopic Resection and Roux-en-Y Hepaticoenterostomy

Abstract

Background/objectiveCholedochal cysts are congenital dilations of the biliary tree. The accepted mode of treatment is total excision with hepaticojejunostomy. In this retrospective study, we present our technique and results of laparoscopic choledochal cyst excisions. MethodsWe retrospectively studied 45 patients who had undergone laparoscopic choledochal cyst excision in our institutes from September 2006 to August 2009. Data including age, gender, type of cyst, symptoms, surgical technique, conversion rate, morbidity, and mortality were analyzed. ResultsThere were type Ic (cystic) choledochal cysts in 31 patients (68.9%) and type If (fusiform) in 14 patients (31.1%). An anomalous pancreaticobiliary duct junction union was found in 66.7%. Forty percent (18 out of 45) and 37.8% (17 out of 45) cases had stones within the cysts and gallbladders, respectively. The average size of the cysts was 40.3±16.9 cm2. The mean operative time was 307.7±58.0 min, the estimated operative blood loss was 252.3±162.5 ml, and the conversion rate was 8.9%. The mean hospital stay was 8.3±3.2 days. The overall morbidity rate was 17.1%, the reoperation rate was zero, and the mortality rate was also zero. ConclusionsTotally, laparoscopic management of type I choledochal cysts, although technically challenging, is safe and feasible in experienced hands.