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Updated: Dec 8, 2025
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Biliary Reconstruction by Isolated Jejunal Interposition Loop: Our Experience after Excision of Choledochal Cyst
Somak Krishna Biswas1, Kalyani Saha Basu1, Sumitra Kumar Biswas1
1Department of Paediatric Surgery, Nilratan Sircar Medical College, Kolkata, West Bengal, India.
Insights
Jejunal interposition loop reconstruction for type I choledochal cysts is safe and reproducible, offering good long-term results. This technique is crucial for pediatric hepatobiliary surgery outcomes.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Gastroenterology
Background:
- Choledochal cysts are common in pediatric surgical practice.
- Total cyst excision with biliary-enteric anastomosis is standard for Type I choledochal cysts.
- Jejunal interposition loop reconstruction is considered a physiologic approach for biliary-enteric reconstruction.
Purpose of the Study:
- To evaluate the safety and efficacy of jejunal interposition loop reconstruction in Type I choledochal cyst patients.
- To assess the morbidity and complications associated with this surgical technique.
Main Methods:
- Retrospective review of patients with Type I choledochal cysts operated between January 2010 and September 2018.
- Analysis of clinical presentation, investigations, operative procedures, morbidity, and complications.
- Focus on patients who underwent jejunal interposition loop reconstruction.
Main Results:
- 33 patients (male:female ratio 1:3, mean age 4.63 years) were included.
- Follow-up ranged from 3 to 81 months (mean 36.30 months).
- No stricture or cholangitis observed; one reoperation for anastomosis leak, one pancreatitis, one prolonged ileus, two spontaneous bile leaks.
Conclusions:
- Jejunal interposition loop reconstruction is a safe and reproducible technique for Type I choledochal cysts.
- Acceptable morbidity rates were observed.
- Abandoning this procedure may lead to elusive long-term benefits.
Background:
Choledochal cyst is a fairly common hepatobiliary condition in pediatric surgical practice. For the most common type (type I), it is well established that the total excision of the cyst with an wide biliary-enteric anastomosis is key for long-term good result. Multiple options remain for biliary-enteric reconstruction after excision. Jejunal interposition loop reconstruction is thought to be the most physiologic.
Materials And Methods:
We have retrospectively reviewed the data of patients of type I choledochal cysts which were operated between January 2010 and September 2018 and undergone jejunal interposition loop reconstruction. Clinical presentation, investigations, operative procedure morbidity and complications were reviewed.
Results:
There were 33 patients, with a male-to-female ratio of 1:3 and a mean age of 4.63 years (mean ± standard deviation [SD] = 4.63 ± 2.98 years). The follow-up period ranged from 3 to 81 months (mean ± SD = 36.30 ± 19.24 months). There was no stricture or cholangitis. Reoperation required in one due to leak at biliary-enteric anastomosis leading to biliary peritonitis. One each had pancreatitis and prolonged ileus. Two bile leaks stopped spontaneously. Operative time and postoperative hospital stay were 228.78 ± 40.43 min (mean ± SD) and 8.96 ± 3.63 days (mean ± SD), respectively.
Conclusion:
Jejunal interposition loop reconstruction is safe and reproducible with acceptable morbidity. However, if this procedure is abandoned, the long-term benefits may remain ever elusive.
