Early Outcome of Laparoscopic Choledochal Cyst Excision with Roux-N-Y Hepaticojejunostomy

Authors

  • Muhammad Bilawal Khan Hayatabad Medical Complex, Peshawar, Pakistan
  • Muhammad Iftikhar Hayatabad Medical Complex, Peshawar, Pakistan
  • Siddique Ahmad Hayatabad Medical Complex, Peshawar, Pakistan
  • Nazia Shahana Services Hospital, Peshawar, Pakistan
  • Rashid Aslam Hayatabad Medical Complex, Peshawar, Pakistan
  • Muhammad Alam Hayatabad Medical Complex, Peshawar, Pakistan
  • Karishma Rehman Khyber Teaching Hospital, Peshawar, Pakistan

DOI:

https://doi.org/10.52206/jsmc.2025.15.2.1010

Abstract

Background: Laparoscopic surgery has replaced conventional surgery due to its efficacy and safety. It offers a minimally invasive alternate to open surgery with faster recovery, lesser pain and complications. Choledochal cyst, a congenital disease, poses a significant challenge for the surgeon due to its complex anatomy and variations. Excising the cyst laparoscopically can significantly aid in reducing the morbidity associated with it.

Objective: The purpose of this study is to share our results of Laparoscopic Choledochal Cysts excision in terms of per-operative and early post-operative complications, in a tertiary care hospital.

Materials and Methods: The study is based on prospective analysis and review of a cohort of 27 patients having age ranging from 18-60 years.  These patients underwent laparoscopic choledochal cyst excision at Department of surgery, Hayatabad Medical Complex Pakistan, during 2022-23. The demographic details, intra-operative characteristics and postoperative outcomes were examined and analyzed. Statistical analyses were conducted by using IBM SPSS 25.0.

Results: The study revealed a significant success rate of 92.6%. Intra-operative blood loss and excision time were within the standard parameters. Post-operative complications included fever (22.2%), upper respiratory tract infection (14.8%), and abscess formation (7.4%). Time to oral feeding was 3.91±1.11 days, and the mean postoperative hospital stay was 5.71±2.01 days. The mortality rate during the three-months follow-up was reported as zero.

Conclusion: Laparoscopic choledochal cyst excision proves to be a suitable and less invasive alternative, with positive early outcomes. The study supports the contemporary shift toward laparoscopic interventions having reduced complications and speedy recovery of the patient.

Key Words: Choledochal cyst, Early outcomes, Hepatobiliary surgery, Laparoscopic excision, Minimally invasive, Postoperative complications.

References

Shim Y, Kang CM. A case of laparoscopic excision of choledochal cyst, hepaticojejunostomy, and Roux-en-Y anastomosis using Artisential. Ann Hepatobiliary Pancreat Surg. 2024;28(2):266-9. https://doi.org/10.14701/ahbps.23-114

Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg. 1977;134:263-9. https://doi.org/10.1016/0002-9610(77)90359-2

Sun R, Zhao N, Zhao K, Su Z, Zhang Y, Diao M, et al. Comparison of efficacy and safety of laparoscopic excision and open operation in children with choledochal cysts: A systematic review and update meta-analysis. PLoS One. 2020;15:e0239857. https://doi.org/10.1371/journal.pone.0239857

Yoon JH, Hwang HK, Lee WJ, Kang CM. Minimally invasive surgery for choledochal cysts: laparoscopic versus robotic approaches. Ann Hepatobiliary Pancreat Surg. 2021;25:71-7. https://doi.org/10.14701/ahbps.2021.25.1.71

Ojha S, Bharadia L, Sharma R, Bansal RK, Chaturvedi A. Laparoscopic choledochal cyst excision and biliary reconstruction in patients with previous surgery/intervention: Feasibility and outcome. J Minim Access Surg. 2024 Apr 1;20(2):121-6. https://doi.org/10.4103/jmas.jmas_269_22

Zheng J, Li Z, Ye Y, Wang B. Short-term complications after laparoscopic choledochal cyst radical surgery: Prevention and treatment. Front Surg. 2020;7:583210. https://doi.org/10.3389/fsurg.2020.583210

Mansy W, El Ekiaby O, Mohamed M. Total cyst excision with Roux-en-Y hepaticojejunostomy for choledochal cyst management: a single-center experience. Egypt J Surg. 2020;39(3):780-6. https://doi.org/10.4103/ejs.ejs_80_20

Yeung F, Fung ACH, Chung PHY, Wong KKY. Short-term and long-term outcomes after Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy following laparoscopic excision of choledochal cyst in children. Surg Endosc. 2020;34(5):2172-7. https://doi.org/10.1007/s00464-019-07004-5

Diao M, Li L, Cheng W. Laparoscopic management for aberrant hepatic duct in children with choledochal cysts. Surg Endosc. 2019;33:2376-80. https://doi.org/10.1007/s00464-019-06807-w

Reyes N, Sotomayor C, Inzunza M, Briceño E, Viñuela E, Martínez J, et al. Type I choledochal cyst. Total laparoscopic resection and Roux-en-Y reconstruction to two separated ducts. J Surg Case Rep. 2024;8(1):15-9. https://doi.org/10.1093/jscr/rjae543

Brown ZJ, Baghdadi A, Kamel I. Diagnosis and management of choledochal cysts. HPB (Oxford). 2023;25:14-25. https://doi.org/10.1016/j.hpb.2022.09.010

Pakkala AK, Nekarakanti PK, Nagari B. An audit of complicated choledochal cysts: 15-years' experience at a tertiary care center. Langenbecks Arch Surg. 2023;408:212. https://doi.org/10.1007/s00423-023-02952-y

Zhang B, Wu D, Fang Y, Bai J, Huang W, Liu M, et al. Early complications after laparoscopic resection of choledochal cyst. Pediatr Surg Int. 2019;35:845-52. https://doi.org/10.1007/s00383-019-04489-y

Aly MYF, Mori Y, Miyasaka Y. Laparoscopic surgery for congenital biliary dilatation: A single-institution experience. Surg Today. 2018;48:44-50. https://doi.org/10.1007/s00595-017-1545-3

Han JH, Lee JH, Hwang DW. Robot resection of a choledochal cyst with Roux-en-Y hepaticojejunostomy in adults: Initial experiences with 22 cases and a comparison with laparoscopic approaches. Ann Hepatobiliary Pancreat Surg. 2018;22:359-66. https://doi.org/10.14701/ahbps.2018.22.4.359

Friedmacher F, Ford KE, Davenport M. Choledochal malformations: Global research, scientific advances, and key controversies. Pediatr Surg Int. 2019;35:273-82. https://doi.org/10.1007/s00383-018-4392-4

Friedmacher F, Pakarinen MP, Rintala RJ. Congenital diaphragmatic hernia: A scientometric analysis of the global research activity and collaborative networks. Pediatr Surg Int. 2018;34:907-17. https://doi.org/10.1007/s00383-018-4304-7

Pilkington M, Grant CN, Geiger JD, Speck KE. Laparoscopic choledochal cyst resection with hepaticoduodenostomy using a novel articulating instrument in a 19-month-old. Videoscopy. 2019;29(6): https://doi.org/10.1089/vor.2019.0600

Additional Files

Published

10-05-2025

How to Cite

1.
Khan MB, Iftikhar M, Ahmad S, Shahana N, Aslam R, Alam M, Rehman K. Early Outcome of Laparoscopic Choledochal Cyst Excision with Roux-N-Y Hepaticojejunostomy. J Saidu Med Coll [Internet]. 2025 May 10 [cited 2025 Jun. 12];15(2):152-6. Available from: https://jsmc.pk/index.php/jsmc/article/view/1010

Issue

Vol. 15 No. 2 (2025): Journal of Saidu Medical College

Section

Original Article

License

Copyright (c) 2024 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.