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Laparoscopic treatment of congenital choledochal cyst
H Shimura1, M Tanaka, S Shimizu
1Department of Surgery 1, Kyushu University Faculty of Medicine, Fukuoka 812-82, Japan.
Insights
Laparoscopic surgery successfully treated a congenital choledochal cyst in a young man experiencing recurrent pancreatitis. This minimally invasive approach offers significant patient benefits despite its complexity.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Congenital choledochal cysts are rare bile duct malformations.
- Type I choledochal cysts with a common pancreatobiliary channel can lead to complications like pancreatitis.
- Surgical intervention is the standard treatment for choledochal cysts.
Observation:
- A 19-year-old male presented with recurrent abdominal pain secondary to pancreatitis.
- Endoscopic retrograde cholangiopancreatography confirmed a Type I choledochal cyst with a common pancreatobiliary duct.
- Laparoscopic excision of the dilated bile duct and gallbladder was performed.
Findings:
- A Roux-en-Y anastomosis was created using an endo-EEA stapler.
- End-to-side hepaticojejunostomy was achieved with continuous suturing using an Endostitch.
- Postoperative hyperamylasemia resolved without further intervention; patient discharged on day 11 with minimal symptoms.
Implications:
- Laparoscopic surgery is a beneficial, albeit complex, treatment option for congenital choledochal cysts.
- Advanced surgical instruments like endostaplers and Endostitch can simplify complex intracorporeal digestive tract reconstruction.
- Minimally invasive techniques in treating choledochal cysts lead to favorable patient outcomes and reduced recovery times.
Abstract:
We describe the laparoscopic treatment of a patient presenting with congenital choledochal cyst. Our patient was a 19-year-old man with a complaint of recurrent abdominal pain due to pancreatitis. The choledochal cyst was type I and had a common channel of pancreatobiliary duct, as revealed by endoscopic retrograde cholangiopancreatography. Under laparoscopic guidance, the dilated bile duct and the gallbladder were excised, and a Roux-en-Y anastomosis was constructed with an endo-EEA. Finally, end-to-side anastomosis was carried out by the continuous suture method, aided by an Endostitch between the stump of the hepatic duct and the Roux-en-Y limb. After the operation, slight hyperamylasemia was observed for several days but further treatment was not necessary. Postoperative symptoms were minimal, and the patient was discharged on the 11th day after the procedure. Although it is difficult and time-consuming, laparoscopic operation is highly beneficial for the patient. The use of such instruments as the endostapler and Endostitch may help to simplify this complex intracorporeal procedure involving division and anastomosis of the digestive tract.