Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background/objective

Choledochal 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.

Methods

We 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.

Results

There 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.

Conclusions

Totally, laparoscopic management of type I choledochal cysts, although technically challenging, is safe and feasible in experienced hands.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Shi LB, Peng SY, Meng XK, Peng CH, Liu YB, Chen XP, Ji ZL, Yang DT, Chen HR. Diagnosis and treatment of congenital choledochal cyst: 20 years’ experience in China. World J Gastroenterol 2001; 7:732–734.

    CAS  PubMed  Google Scholar 

  2. Nagorney DM. Bile duct cysts in adults. In Blumgart LH, Fong Y, eds. Surgery of the liver and biliary Tract, vol. 2, 3rd ed. London: Saunders, 2000, pp 1229–1244.

    Google Scholar 

  3. Lilly JR.Total excision of choledochal cyst. Surg Gynecol Obstet 1978;146:254–256.

    CAS  PubMed  Google Scholar 

  4. de Vries JS, de Vries S, Aronson DC, Bosman DK, Rauws EA, Bosma A, Heij HA, Gouma DJ, van Gulik TM. Choledochal cysts: age of presentation, symptoms and late complications related to Todani’s classification. J Pediatr Surg 2002;37:1568–1573

    Article  PubMed  Google Scholar 

  5. Liu CL, Fan ST, Lo CM, Lam CM, Poon RT, Wong J. Choledochal cysts in adults. Arch Surg 2002;137:465–468

    Article  PubMed  Google Scholar 

  6. Singham J, Schaeffer D, Yoshida E, Scudamore C. Choledochal cysts: analysis of disease pattern and optimal treatment in adult and paediatric patients. HPB(Oxford) 2007; 9:383–387

    Google Scholar 

  7. Söreide K, Körner H, Havnen J, Söreide JA. Bile duct cysts in adults. Br J Surg 2004;91:1538–1548

    Article  PubMed  Google Scholar 

  8. Farello GA, Cerofolini A, Rebonato M, Bergamaschi G, Ferrari C, Chiappetta A. Congenital choledochal cyst: video-guided laparoscopic treatment. Surg Laparosc Endosc 1995;5:354–358.

    CAS  PubMed  Google Scholar 

  9. Shimura H, Tanaka M, Shimizu S, Mizumoto K. Laparoscopic treatment of congenital choledochal cyst. Surg Endosc 1998;12:1268–1271

    Article  CAS  PubMed  Google Scholar 

  10. Ure BM, Schier F, Schmidt AI, Nustede R, Petersen C, Jesch NK. Laparoscopic resection of congenital choledochal cyst, choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis. Surg Endosc 2005;19:1055–1057.

    Article  CAS  PubMed  Google Scholar 

  11. Lee H, Hirose S, Bratton B, Farmer D. Initial experience with complex laparoscopic biliary surgery in children: biliary atresia and choledochal cyst. J Pediatr Surg 2004;39:804–807, discussion 804–807.

    Article  PubMed  Google Scholar 

  12. Aspelund G, Ling SC, Ng V, Kim PC. A role for laparoscopic approach in the treatment of biliary atresia and choledochal cysts. J Pediatr Surg 2007;42:869–872.

    Article  PubMed  Google Scholar 

  13. Martinez-Ferro M, Esteves E, Laje P. Laparoscopic treatment of biliary atresia and choledochal cyst. Semin Pediatr Surg 2005;14:206–215.

    Article  PubMed  Google Scholar 

  14. Liu DC, Rodriguez JA, Meric F, Geiger JL. Laparoscopic excision of a rare type II choledochal cyst: case report and review of the literature. J Pediatr Surg 2000;35:1117–1119.

    Article  CAS  PubMed  Google Scholar 

  15. Tan HL, Shankar KR, Ford WD. Laparoscopic resection of type I choledochal cyst. Surg Endosc 2003;17:1495.

    Article  CAS  PubMed  Google Scholar 

  16. Jang JY, Kim SW, Han HS, Yoon YS, Han SS, Park YH. Totally laparoscopic management of choledochal cysts using a four-hole method. Surg Endosc 2006;20:1762–1765.

    Article  PubMed  Google Scholar 

  17. Watanabe Y, Sato M, Tokui K, Koga S, Yukumi S, Kawachi K. Laparoscope-assisted minimally invasive treatment for choledochal cyst. J Laparoendosc Adv Surg Tech A 1999;9:415–418.

    Article  CAS  PubMed  Google Scholar 

  18. Vila-Carbó JJ, Lluna González J, Hernández Anselmi E, Nome Farbinger C, Ayuso González L, Marco Macián A. Congenital choledochal cyst and laparoscopic techniques. Cir Pediatr 2007;20:129–132.

    PubMed  Google Scholar 

  19. Li L, Feng W, Jing-Bo F, Qi-Zhi Y, Gang L, Liu-Ming H, Yu L, Jun J, Ping W. Laparoscopic-assisted total cyst excision of choledochal cyst and Roux-en-Y hepatoenterostomy. J Pediatr Surg 2004;39:1663–1666.

    Article  PubMed  Google Scholar 

  20. Tanaka M, Shimizu S, Mizumoto K, Yokohata K, Chijiiwa K, Yamaguchi K, Ogawa Y. Laparoscopically assisted resection of choledochal cyst and Roux-en-Y reconstruction. Surg Endosc 2001;15:545–552

    Article  CAS  PubMed  Google Scholar 

  21. Jordan PH Jr, Goss JA Jr, Rosenberg WR, Woods KL. Some considerations for management of choledochal cysts. Am J Surg 2004;187:790–795.

    Article  PubMed  Google Scholar 

  22. Srimurthy KR, Ramesh S. Laparoscopic management of pediatric choledochal cysts in developing countries: review of ten cases. Pediatr Surg Int 2006;22:144–149.

    Article  CAS  PubMed  Google Scholar 

  23. Ohi R, Yaoita S, Kamiyama T, Ibrahim M, Hayashi Y, Chiba T. Surgical treatment of congenital dilatation of the bile duct with special reference to late complication after total excisional operation. J Pediatr Surg 1990;25:613–617.

    Article  CAS  PubMed  Google Scholar 

  24. Stain SC, Guthrie CR, Yellin AE, Donovan AJ. Choledochal cyst in the adult. Ann Surg 1995; 222:128–133.

    Article  CAS  PubMed  Google Scholar 

  25. Hewitt PM, Krige JE, Bornman PC, Terblanche J. Choledochal cysts in adults. Br J Surg 1995; 82:382–385.

    Article  CAS  PubMed  Google Scholar 

  26. Lipsett PA, Pitt HA, Colombani PM, Boitnott JK, Cameron JL. Choledochal cyst disease. A changing pattern of presentation. Ann Surg 1994; 220:644–652.

    Article  CAS  PubMed  Google Scholar 

  27. Chijiiwa K, Tanaka M. Late complications after excisional operation in patients with choledochal cyst. J Am Coll Surg 1994; 179:139–144.

    CAS  PubMed  Google Scholar 

  28. Todani T, Watanabe Y, Urushihara N, Noda T, Morotomi Y. Biliary complications after excisional procedure for choledochal cyst. J Pediatr Surg 1995;30:478–481.

    Article  CAS  PubMed  Google Scholar 

  29. Miyano T, Yamataka A, Kato Y, Segawa O, Lane G, Takamizawa S, Kohno S, Fujiwara T. Hepaticoenterostomy after excision of choledochal cyst in children; a 30 year experience with 180 cases. J Pediatr Surg 1996;31:1417–1421

    Article  CAS  PubMed  Google Scholar 

  30. Watanabe Y, Toki A, Todani T. Bile duct cancer developed after cyst excision for choledochal cyst. J Hepatobiliary Pancreat Surg 1999;6: 207–212

    Article  CAS  PubMed  Google Scholar 

  31. Chen HM, Jan YY, Chen MF, Wang CS, Jeng LB, Hwang TL, Chen SC, Chao TC. Surgical treatment of choledochal cyst in adults: results and long-term follow-up. Hepatogastroenterology 1996;43:1492–1499.

    CAS  PubMed  Google Scholar 

  32. Abbas HM, Yassin NA, Ammori BJ. Laparoscopic resection of type I choledochal cyst in an adult and Roux-en-Y hepaticojejunostomy: a case report and literature review. Surg Laparosc Endosc Percutan Tech 2006;16:439–444.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Biliary and Vascular Surgery Unit, Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, People’s Republic of China

    Yu Tian & Shuo-Dong Wu

  2. Department of General Surgery, Qianwei Hospital, Changchun, People’s Republic of China

    An-Dong Zhu & De-Xing Chen

Authors
  1. Yu Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuo-Dong Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. An-Dong Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. De-Xing Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shuo-Dong Wu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tian, Y., Wu, SD., Zhu, AD. et al. Management of Type I Choledochal Cyst in Adult: Totally Laparoscopic Resection and Roux-en-Y Hepaticoenterostomy. J Gastrointest Surg 14, 1381–1388 (2010). https://doi.org/10.1007/s11605-010-1263-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-010-1263-2

Keywords

Search

Navigation