Laparoscopic Management of Choledochal Cyst-Technical Modifications and Outcome Analysis

• Published in: World journal of surgery 2015-10, Vol.39 (10), p.2550-2556
• Main Authors: Senthilnathan, Palanisamy, Patel, Nikunj D., Nair, Arun S., Nalankilli, V. P., Vijay, Anand, Palanivelu, Chinnusamy
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adolescent; Adult; Adult Group; Aged; Blood Loss, Surgical; Cardiac Surgery; Child; Child, Preschool; Cholangitis; Cholangitis - etiology; Choledochal Cyst; Choledochal Cyst - surgery; Conversion to Open Surgery; Female; General Surgery; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Operative Time; Original Scientific Report; Pancreatitis; Pediatric Group; Reoperation; Retrospective Studies; Surgery; Thoracic Surgery; Treatment Outcome; Vascular Surgery; Young Adult
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-015-3111-8

Background Choledochal cyst (CDC) is a well described albeit rare clinical entity. Complete cyst excision with biliary-enteric reconstruction is the recommended treatment for Todani type I, II, and IVA cysts to prevent complications. The aim of this study is to evaluate outcomes of laparoscopic CDC excision from a tertiary care center. Methods This is a retrospective analysis of prospectively collected data of 110 patients who underwent laparoscopic cyst excision and biliary-enteric reconstruction for CDC type I and IVA from 1998 to 2013. Results Out of 110 patients, 55 were children (16 years) with mean age 21.19 ± 17.75 years and male:female ratio of 1:2.14. Abdominal pain was the most common presenting symptom (59.09 %). Surprisingly, 32.73 % of adults presented with incidentally detected cyst. Type I cyst was the most common (71.82 %) with mean size of 4.67 ± 1.59 cm. Blood loss (56.0 ± 16.62 vs. 76.55 ± 26.61 ml) and operative time (199.8 ± 44.66 vs. 251.6 ± 54.25 min) were significantly low in pediatric group. Three adults required conversion. Overall complication rate was 10 %. Re-exploration rate was 1.81 % with one patient died post-operatively. Mean hospital stay was significantly low in children (5.9 ± 1.39 vs. 7.0 ± 2.66 days). Median follow-up was 60 months (8–110). Cholangitis developed in six patients with three having anastomotic stricture requiring intervention. Conclusion Laparoscopic excision of CDC is safe and feasible. Surgery should be performed early as outcomes are better in pediatric age as compared to adults.