Laparoscopically assisted resection of choledochal cyst and Roux-en-Y reconstruction

Laparoscopic surgery for a congenital choledochal cyst was accomplished in five of eight adult patients for whom it was attempted (63%). Creation of a Roux-en-Y jejunal limb by midline minilaparotomy and hepaticojejunostomy u sing a laparoscopic sewing instrument facilitated the procedure. Background: Congenital choledochal cyst is a good indication for laparoscop ic surgery. However, only two case reports are available at this writing. Methods: Eight adult patients, ages 19 to 61 years (mean, 32.6 years), unde rwent laparoscopically assisted resection of the choledochal cyst and Roux- en-Y hepaticojejunostomy. Results: The whole procedure was accomplished in five patients (63%). The d uration of the procedure ranged from 525 to 680 min (average. 616 min). Ope n conversion in three patients was necessitated by severance of a small com mon hepatic duct because of disorientation caused by previous laparoscopic cholecystectomy, electrocautery injury to the common channel distal to the anomalous pancreaticobiliary junction, or heavy adhesion around the cyst se condary to recent severe cholangitis. Creation of a Roux-en-Y jejunal limb by midline minilaparotomy and hepaticojejunostomy using a laparoscopic sewi ng instrument facilitated the procedure. Conclusions: Laparoscopically assisted resection of the choledochal cyst an d hepaticojejunostomy are technically feasible and deserve further clinical trials.