Laparoscopic Excision Of Adult Choledochal Cyst, And Clinical Analysis In Two Cases

Object:We present our technique and results of laparoscopic choledochal cyst excisions in order to study and research safety and feasibility of the operation.Methods:We retrospectively studied 2 adult patients, type-I choledochal cyst patients who had undergone laparoscopic choledochal cyst excision in our institutes in 2010.1. Clinical data:Two patients were identified, one was male of 35-years-old, and another was female of 29-years-old.The main symptom of two patients was abdomin-al pain. There was no jaundice and abdominal mass. Cysts were classified according to the Todani modification of system of Alonso-Lej:There were type I cysts, which are completely extra-hepatic. Two patients underwent blood-RT hematological liver function and other routine blood tests, chest radiograph, electrocardiography, abdominal type-B ultrasound, abdominal computed tomography(CT).and magnetic resonance cholangiopancreatography (MRCP) as part of the preoperative routine workup. The abdominal type-B ultrasound, abdominal computed tomography (CT),and magnetic resonance cholangiopancreatography (MRCP) of two patients reported choledochal cysts.2. Operative Technique:General anesthesia. Five Trocars(Fig2),Under Laparoscopic guidance, gallbladder and choledochal cysts were dissected by ultrasonic scalpel (Proximal choledochal cyst was dissected at the junction of common bile duct and common hepatic duct. And distal choledochal cyst was dissected at the junction of cyst and pancreatic duct).It is required to excise choledochal cysts thoroughly. The ligament of Treitz was identified under laparoscopy,and the proximal jejunum 20cm distal to the ligament was severed by Endo-GIA 60 and with a bowel clamp inserted through the upper central trocar. Extending the central trocar site after cessation of pneumoperitoneum, a 4-cm-long incision was made. The jejunum was exteriorized and Roux-en-Y jejunum anastomosis was conducted in erthyphoria, and the jejunum returned to abdominal cavity. Hepaticoenterostomy of the posterior surface of colon was conducted Under Laparoscopic guidance.Result:The laparoscopic operative procedure was successfully accomplished in two patients and two patients were successfully discharged from the hospital. The estimated operative blood loss was 175ml, the mean operative time was 340 min. Two patients were out-of-bed activity on the first postoperative day, and consumed liquid food on the third or fourth postoperative day respectively. Two patients were not found to have bile, pancreatic juice and intestinal juice leakage complication. The mean post-op hospital stay was 7 days. Pathology demonstrated that two patients were congenital choledochal cysts. After a follow-up visit ranging 12 months to 14 months, the two patients did not appear to have short term complication.Conclusions:Laparoscopic management of type I choledochal cysts in adult patients, although technically challenging, is safe, small operative incision, less loss of blood, quicker resumption of peristalsis, excellent cosmesis, short-hospital stay and feasible in experienced hands.