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Zhuo Y, Yang X, Du J, Jiang H, Sun X, Chen G, He K, Zhang W, Liao J, Gu H. Whole-Course Intraperitoneal Robot-Assisted Choledochal Cyst Excision with a Hidden Incision in Children Under 1 Year Old. J Laparoendosc Adv Surg Tech A 2024; 34:448-457. [PMID: 38126886 DOI: 10.1089/lap.2023.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background: Whole-course intraperitoneal robot-assisted choledochal cyst resection in children under 1 year of age is controversial due to its technical challenges. Current Pfannenstiel incision is widely used in adults for its cosmetic effects but is rarely used in children. Materials and Methods: We conducted a prospective, single-center study to assess the feasibility, safety, and cosmesis of whole-course intraperitoneal robot-assisted choledochal cyst resection with Pfannenstiel incision in children under 1 year of age. Results: Ten patients were treated with our surgical protocol, and there was no conversion to laparotomy. The average total operation time was 223 minutes. The average duration of anesthesia was 260.2 minutes. The average docking time between the robot arm and Trocar was 17.5 minutes. The average intraoperative blood loss was 16 mL. No postoperative complications occurred in the 10 patients. The mean time to start drinking water after surgery was 2.4 days. The mean postoperative drainage tube removal time was 2.6 days. The average length of stay was 8.5 days. The scar assessment scale total scores of the 2 observers were (6.8 ± 1.23) and (7.4 ± 1.84), respectively. For every patient, there are only four abdominal surgery scars of which 75% of scars were hidden by underpants and 25% of scars were not covered. Conclusion: It is feasible and safe to perform whole-courses intraperitoneal robot-assisted choledochal cyst resection with Pfannenstiel incision in children under 1 year old. It also has a hidden incision effect and is worthy of promotion.
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Affiliation(s)
- Yingquan Zhuo
- Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Xianwu Yang
- Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Jun Du
- Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Hua Jiang
- Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xu Sun
- Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Guangtang Chen
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Kunfeng He
- Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Wengqi Zhang
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jun Liao
- Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Huajian Gu
- Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
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Li B, Chen BW, Xia LS. The Initial Experience of Laparoscopic Management for Type VI Choledochal Cyst in Children. J Laparoendosc Adv Surg Tech A 2024; 34:280-283. [PMID: 37844069 DOI: 10.1089/lap.2023.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Purposes: Dilatation of cystic duct is very rare and had been classified as Todani type VI choledochal cyst. Choledochal cyst combined with dilatation of cystic duct is difficult to diagnose preoperatively. The purpose of this study is to report the rare variants and discuss the significance and laparoscopic management strategy in children. Methods: The subjects for this study were 10 consecutive patients with type VI choledochal cyst who had laparoscopic procedures at our institute between January 2009 and January 2023. Laparoscopic cholecystectomy, excision of the dilated cystic duct, and choledochal cyst were carried out, and the continuity of the biliary duct was re-established through a Roux-en-Y hepaticojejunostomy. Results: Cystic duct combined with the common bile duct dilatation was revealed in all the patients intraoperatively. Laparoscopic procedures were completed with no conversions. The postoperative recovery was uneventful. The mean follow-up duration was 27 ± 12.7 months (range 5-36 months) with no postoperative complications encountered. Conclusions: The rare entity of type VI choledochal cyst should be recognized as a distinct type of choledochal cyst and need to be given enough attention clinically. The laparoscopic procedure is a feasible option for experienced surgeons.
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Affiliation(s)
- Bing Li
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
| | - Bing Wei Chen
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
| | - Lin Shun Xia
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
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Cheng L, Peng S, Huo S, Liu W. Risk factors for the development of biliary tract infection after choledochal-malformation surgery. Asian J Surg 2023; 46:478-482. [PMID: 35697611 DOI: 10.1016/j.asjsur.2022.05.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/28/2022] [Accepted: 05/26/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To explore the risk factors of biliary tract infection after bile duct dilatation surgery. METHODS The study included 135 patients with choledochal malformation after bile duct dilatation surgery at our hospital from January 2019 to June 2021. We analyzed general data of infected and uninfected groups after bile duct dilatation surgery. Single/multiple factor logistic regression was used to analyse the factors influencing postoperative biliary tract infection in bile duct dilatation. RESULTS There were statistically significant differences in preoperative history of biliary tract infection, partial hepatectomy, hilar anastomosis, and Todani staging between the two groups. Single factor Logistic regression analysis showed that preoperative history of biliary tract infection, partial hepatectomy, hepatic portal anastomosis and Todani staging IV and V were positively correlated with postoperative biliary tract infection following biliary duct dilatation (P<0.05). In addition, logistic regression analysis of these general data with differential indicators as independent variables and postoperative biliary tract infection in biliary duct dilatation as a dependent variable showed that history of preoperative biliary tract infection and hepatic portal anastomosis were risk factors of postoperative biliary tract infection following biliary duct dilatation. CONCLUSION Risk factors of biliary tract infection after bile duct dilatation include a history of preoperative biliary tract infection and hepatoportal anastomosis, which should be noted during clinical procedures to prevent or reduce the development of biliary tract infection after bile duct dilatation.
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Affiliation(s)
- Lin Cheng
- Outpatient Department, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Sisi Peng
- General Department, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Shuyu Huo
- Department of Hospital Infection Management, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China.
| | - Wen Liu
- Department of Hepatological Surgery, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China.
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Gyawali S, Adhikari G, Shrestha S, Pradhan S, Bhandari RS. Concomitant hilar cholangiocarcinoma with choledochal cyst and cholelithiasis in an asymptomatic patient: A case report. Int J Surg Case Rep 2021; 84:106094. [PMID: 34139420 PMCID: PMC8219770 DOI: 10.1016/j.ijscr.2021.106094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/23/2021] [Accepted: 06/05/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Choledochal cyst is an important risk factor for cholangiocarcinoma. Concomitant hilar cholangiocarcinoma with choledochal cyst with cholelithiasis is a rare finding. CASE PRESENTATION A 52-year-old male presented with non-specific complaints of generalized weakness for 3 months. Transabdominal ultrasound showed dilated common bile duct with hyperechoic mass at hilar region; further evaluation with magnetic resonance cholangiopancreatography and contrast-enhanced computer tomography of abdomen and pelvis revealed concomitant intraductal hilar cholangiocarcinoma (Bismuth Corlette type 1) with Choledochal cyst (type IVa) with cholelithiasis. After optimization patient underwent left hepatectomy with common bile duct excision with cholecystectomy with Roux-en-Y hepaticojejunostomy. Histopathological examination confirmed it to be well-differentiated adenocarcinoma, intestinal type at the hilar confluence. CLINICAL DISCUSSION An asymptomatic male patient with the concomitant finding of perihilar cholangiocarcinoma (Bismuth Corlette type I) with choledochal cyst type IVa with cholelithiasis is a rare finding. The patient was managed with surgical excision of the common bile duct with Roux-en-Y hepaticojejunostomy and cholecystectomy. Diagnostic evaluation should be proper not to miss or overlook such a synchronous lesion. CONCLUSION Incidental finding of concomitant perihilar cholangiocarcinoma with the choledochal cyst is rare. Proper evaluation of the patient with CECT abdomen and pelvis and MRCP is necessary for the diagnosis. Proper surgical resection with adequate lymph node removal is important for surgical clearance.
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Affiliation(s)
- Sushil Gyawali
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
| | - Gagan Adhikari
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Sujan Shrestha
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Sumita Pradhan
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Ramesh Singh Bhandari
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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Gan DEY, Alagoo D, Chan KH, Choi RXY, Sellappan H, Sharif MS, Hayati F. Choledochal cyst and aberrant biliary configuration along with situs inversus totalis: a case report. Pan Afr Med J 2021; 38:398. [PMID: 34381542 PMCID: PMC8325473 DOI: 10.11604/pamj.2021.38.398.29228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 11/21/2022] Open
Abstract
Situs inversus totalis is the complete transpositioning of thoracoabdominal viscera into a mirror image of the normal configuration. Choledochal cyst is the congenital cystic dilation of the biliary tract. Both these conditions coexisting in a patient is extremely rare. We hereby present a case of type IC choledochal cyst in a patient with situs inversus totalis presenting with biliary sepsis secondary to choledocholithiasis. Also detailed are the management and operative strategies employed to deal with this rare entity.
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Affiliation(s)
- David Eng Yeow Gan
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia.,Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Dinesh Alagoo
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Kheng Hooi Chan
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia.,Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Rebecca Xin Yee Choi
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Harivinthan Sellappan
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | | | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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Xuan NT, Son NH, Thien HH. Is the laparoscopic choledochal cyst excision and Roux-En-Y hepaticojejunostomy in adults as safe as that in children? EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-00034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Аbstrаct
Bаckgrоund
Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for treating congenital choledochal cysts has been proven to be efficacious in children, but its safety and efficacy in adult patients remain uncertain. This study aims to investigate the safety and effectiveness of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in adults compared to those in children patients.
Results
There was no conversion to open surgery in both groups. The mean operative time and hospital duration stay in adults (253.4 min and 11.7 days, respectively) were longer in than those in children (214.7 min and 9.3 days, respectively). Intrаоperаtive blооd trаnsfusiоn wаs required in one adult and twо children. There was not reoperation due to bile leakage in adults compared to those in 2 children. The time frоm surgery tо drаinаge remоvаl wаs longer in adults (3.6 vs. 2.9 days). The outcome within three months of discharge was classified as good in 88.2 % of adults and 90.5% for children. There were nо stаtisticаlly significаnt differences in eаrly pоstоperаtive cоmplicаtiоns оr treаtment оutcоmes between the twо grоups.
Cоnclusiоns
Lаpаrоscоpic chоledоchаl cyst excisiоn fоllоwed by Rоux-en-Y hepаticоjejunоstоmy wаs sаfe аnd efficient in bоth аdults аnd children. Оperаtive time wаs lоnger in аdults thаn in children.
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Guan H, Chen R, Li D, Hoosen R, Xie S, Chen C, Jin S. Potential Risk Factors and Prognostic Evaluation of Malignant Changes Following Congenital Choledochal Cyst: a Retrospective Analysis. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Gündoğan E, Sümer F, Çolakoğlu MK, Çiçek E, Gökler C, Aydın MC, Kayaalp C. Laparoscopic resection of choledochal cysts in adults: a series from Turkey. Turk J Surg 2020; 35:223-226. [PMID: 32550332 DOI: 10.5578/turkjsurg.4331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/20/2018] [Indexed: 11/15/2022]
Abstract
Objectives Choledochal cyst is a congenital disease in which surgical treatment is preliminary because of the potential for malignancy. In recent years, increase in technological developments and laparoscopic experience have popularised the use of laparoscopy in adult choledochal cyst surgery. This study aimed to present the results of eight adult patients undergoing laparoscopic choledochal excision surgery. Material and Methods Patients who underwent laparoscopic choledochal cyst excision and hepatico-jejunostomy anastomoses between the years 2013 and 2018 were evaluated retrospectively. Demographic characteristics, preoperative and postoperative findings, pathological results and final condition of the patients were examined. Results Of the eight patients, three were males and five were females. Median age was 41.5 years (22-49). One of the patients had Type IVa and the rest had Type I choledochal cysts. Laparoscopic choledochal cyst excision, cholecystectomy, and hepatico-jejunostomy anastomoses were performed on all of the patients. One patient was converted to open surgery. Three patients had postoperative biliary leakage. Duration of the operations was determined as median 330 (240-480) minutes and blood loss was 50 (10-100) mL. Hospitalization of the patients was median 6 (4-23) days and follow-up time was median 20 (2-65) months. In the late period, cholangitis occured in a patient who was treated with medical therapy and there was no mortality in the follow-up period. Conclusion We suggest that laparoscopic choledochal cyst excision in adults may be an alternative to open surgery due to the satisfactory results in the late period in spite of early problems like self-limiting bile leakage.
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Affiliation(s)
- Ersin Gündoğan
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Fatih Sümer
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| | | | - Egemen Çiçek
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Cihan Gökler
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Mehmet Can Aydın
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Cüneyt Kayaalp
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
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Gaffley M, Munden M, Zeller KA. A 7-Year-Old Boy with a Type IVA Choledochal Cyst Including a Cystic Duct Cyst: Repeating the Call to Further Modify the Todani Classification to Allow for Inclusion of Cystic Duct Cysts. Am Surg 2019. [DOI: 10.1177/000313481908501110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michaela Gaffley
- Department of Surgery Wake Forest University School of Medicine Winston-Salem, North Carolina
| | - Martha Munden
- Department of Surgery Wake Forest University School of Medicine Winston-Salem, North Carolina
| | - Kristen A. Zeller
- Department of Surgery Wake Forest University School of Medicine Winston-Salem, North Carolina
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Xuan NT, Thien HH, Vu PA, Thanh PH, Du Vinh N, Thanh DN, Son NH, Hiep PN. WITHDRAWN: Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy: A comparative study between children and adults. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Han JH, Lee JH, Hwang DW, Song KB, Shin SH, Kwon JW, Lee YJ, Kim SC, Park KM. Robot resection of a choledochal cyst with Roux-en-y hepaticojejunostomy in adults: Initial experiences with 22 cases and a comparison with laparoscopic approaches. Ann Hepatobiliary Pancreat Surg 2018; 22:359-366. [PMID: 30588527 PMCID: PMC6295367 DOI: 10.14701/ahbps.2018.22.4.359] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 10/27/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023] Open
Abstract
Backgrounds/Aims In adult choledochal cysts, complete excision of cyst with Roux-en-Y hepaticojejunostomy by laparoscopy is typically been performed, but there is now a trend towards adopting robot-assisted resection. Methods From January 2014 to December 2017, 22 patients who underwent robotic procedure were classified as Group 1, and 34 patients who underwent the same laparoscopic procedure as Group 2. In addition, from September 2009 to July 2011, 13 patients who underwent laparoscopic procedure were classified as Group 3. The perioperative outcomes and short-term postoperative morbidity levels were evaluated in three groups. Results In all groups, there were more women than men, and the mean age and BMI did not differ significantly. Since 2014, jejunojejunostomy was performed extracorporeally and the mean operation time was shorter in Group 1 (258.5±52.9 min) and Group 2 (236.2±62.9 min) than Group 3 (395.2±85.9 min). [p=0.00 (1 vs 3), 0.00 (2 vs 3)] The median hospital stay was 7 days in Group 1 and 2, and shorter than 9 days in Group 3. [p=0.00 (1 vs 3), 0.011 (2 vs 3)] In Group 1, there were three postoperative complications, which included cholangitis, bile leakage and umbilical herniation, respectively). In Group 2, there were seven of postoperative complications, which included choledochojejunostomy site stricture & intrahepatic duct stone, choledochojejunostomy site stone, jejunal branch bleeding, portal vein thrombus, acute pancreatitis, adhesive ileus, and A-loop syndrome. In Group 3, there were three of postoperative complications, which included 2 hepaticojejunostomy site stricture and 1 paralytic ileus. Conclusions Robot-assisted resection of a choledochal cyst with Roux-en-y hepaticojejunostomy is a safe and feasible approach with short-term results that are comparable to those of laparoscopic surgery.
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Affiliation(s)
- Jang Hun Han
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Woo Kwon
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Joo Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang Min Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Meschino M, García-Ochoa C, Hernandez-Alejandro R. Ruptured choledochal cyst: a rare presentation and unique approach to management. Hepatobiliary Surg Nutr 2015; 4:E8-E12. [PMID: 25713811 DOI: 10.3978/j.issn.2304-3881.2014.08.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/21/2014] [Indexed: 12/28/2022]
Abstract
We present the rare case of a ruptured choledochal cyst (CC) in a young woman presenting with a two-day history of worsening upper abdominal pain. Imaging revealed a contracted gallbladder, dilated common bile duct (CBD), and a large amount of peritoneal fluid. Percutaneous paracentesis was performed, obtaining bilious fluid. Further imaging revealed cystic dilatation of the CBD and the diagnosis of rupture CC type I was made. The patient was initially managed conservatively with percutaneous drains, IV antibiotic therapy, and sphincterotomy through an ERCP. Elective cyst resection and Roux-en-Y hepatojejunostomy was performed 8 weeks later. It is important to differentiate a ruptured CC from other surgical emergencies without exploratory laparotomy. Initial conservative management could be considered, followed by elective resection once inflammation, infection, and other complications have resolved, avoiding the increased risk associated with an emergency operation or two-stage laparotomy.
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Affiliation(s)
- Michael Meschino
- London Health Sciences Centre, Western University, London, ON, Canada
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13
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Hybrid laparoscopic-robotic management of type IVa choledochal cyst in the setting of prior Roux-en-Y gastric bypass: video case report and review of the literature. Surg Endosc 2014; 29:1648-54. [PMID: 25492448 DOI: 10.1007/s00464-014-3937-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 10/06/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Choledochal cysts are rare congenital disease of the biliary system. The recommended treatment of these lesions is surgical excision with biliary enteric reconstruction. In patients with normal anatomy, Roux-en-Y hepaticojejunostomy is preferred. However, different options in biliary reconstruction must be entertained in those with abnormal anatomy. METHODS Our patient is a 39-year-old female, who during workup for bariatric surgery two years prior to presentation, was found to have a 6 cm dilation of her common bile duct. She underwent a laparoscopic Roux-en-Y gastric bypass (LRYGB) in 2011 at an outside facility, with no planned intervention on her biliary tree. Ultimately, she developed right upper quadrant pain two years following her RYGB. Upon further workup including right upper quadrant ultrasound, an extrahepatic choledochal cyst was confirmed and she was referred to our institution for definitive care. RESULTS The patient was taken to the operating room for resection of the choledochal cyst with hepatoenteric reconstruction. The dissection and resection of the cyst commenced laparoscopically. After performing a generous Kocher maneuver, we demonstrated that there was adequate mobilization of the duodenum to perform a tension free hepaticoduodenostomy, which was performed robotically. Her postoperative course was uneventful, and she was discharged home on postoperative day 3. At one month follow up, the patient was doing well with symptom resolution. Her final pathology revealed a choledochal cyst which was negative for dysplasia or carcinoma. Long-term follow up has been recommended with yearly alkaline phosphatase levels. CONCLUSIONS Here we present a video of the technical considerations during a robot-assisted laparoscopic biliary reconstruction in a patient with a prior Roux-en-Y gastric bypass with a type IVA choledochal cyst.
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