Chinnusamy Palanivelu, MCH, FACS; Palanisamy Senthilnathan, MS; Saravanan Senthilkumaran, MS; M. Velusamy Madhan Kumar, MS; Muthukumaran Rangarajan, MS
Choledochal cysts are congenital dilatations of the extra hepatic biliary system that typically affect the pediatric population. We present our technique of choledochal cyst excision with reconstruction.
The position of the ports and the team setup will be demonstrated in the video. The peritoneum over the cyst just superior to first part of duodenum was incised and the duodenum mobilized to expose the inferior part of the cyst. The cyst is decompressed and opened by a transverse incision. The mobilization of the cyst is extended inferiorly up to the distal limit of the cyst. The distal bile duct is divided and sutured. An attempt is always made to demonstrate the junction of the choledochal cyst and the pancreatic duct. The dissection is extended cranially up to the level of the normal sized hepatic ducts and the cyst was excised in to-to. A Roux-en-Y loop of jejunum is created either laparoscopically or by assisted method and the hepatico jejunostomy was performed in an end to side fashion by intracorporeal suturing. The ports were closed under vision after placement of a drain in the sub hepatic space along with a decompression tube across the anastomosis.