"Endoscopy friendly" resection technique of choledochal cysts

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Reconstruction Techniques
• Pediatric and Adult Surgical Conditions

Background:

• Choledochal cysts are congenital dilations of the biliary tree, often requiring surgical intervention.
• Todani type IVa choledochal cysts involve multiple dilatations of both intrahepatic and extrahepatic bile ducts.
• Surgical management aims to resect the cyst and reconstruct biliary-intestinal continuity to prevent complications.

Observation:

• Two adult patients (22 and 31 years old) with Todani IVa choledochal cysts underwent surgical resection.
• Biliary-intestinal reconstruction was achieved using a 15 cm interpositional jejunal segment connecting the liver hilum to the duodenum.
• Postoperative endoscopic evaluation was performed 5-6 months after surgery.

Findings:

• The hepatico-jejunostomy anastomoses were patent in both patients.
• No signs of biliary reflux into the hepatico-jejunostomy were observed.
• Absence of cholangitis indicated successful biliary drainage and restoration of function.

Implications:

• This surgical approach demonstrates a safe and effective method for reconstructing biliary-intestinal drainage after choledochal cyst resection in adults.
• Maintaining patent anastomoses and preventing reflux/cholangitis are critical for long-term patient outcomes.
• Further studies may explore long-term efficacy and patient-reported outcomes of this technique.