Laparoscopic choledochal cyst excision with intraoperative cholangiogram, hepatic duct cholangioscopy, extracorporeal Roux-en-Y hepaticojejunostomy and closure of mesenteric defects
Epublication WebSurg.com, May 2016;16(05). URL: http://websurg.com/doi/vd01en4697
The laparoscopic treatment of a choledochal cyst begins with a careful preoperative understanding of the anatomy, including bile ducts, as well as the presence of any abnormal pancreatobiliary anatomy. If a hepaticojejunostomy using a Roux-en-Y anastomosis is performed, we prefer an extracorporeal, transumbilical anastomosis, with a retrocolic approach. A series of interrupted or continuous absorbable sutures can be used for the bilioenteric anastomosis. For the last part of the procedure, we emphasize the importance of closure of mesenteric defects with non-absorbable sutures, including both the retrocolic space and Petersen’s defect to prevent future internal herniations.