Ramírez-Madera F, Vázquez-Serrato MC, Monroy-Barrera ZH, Gil-Hurtado E

Language: Spanish
References: 13
Page: 112-117
PDF size: 1767.96 Kb.

ABSTRACT

Introduction: choledochal cysts are a rare clinical entity, but they have significant diagnostic and therapeutic implications due to their potential for malignant transformation and association with complications such as cholangitis or pancreatitis. Objective: to present the diagnostic and therapeutic approach in the clinical case of a patient with a type IV-A choledochal cyst, managed by minimally invasive surgery and a description of the laparoscopic surgical technique. Clinical case: a patient with a type IV-A choledochal cyst was diagnosed after resolving acute pancreatitis. The patient underwent elective laparoscopic surgery with complete cyst resection and Roux-en-Y hepaticojejunostomy. The patient had a satisfactory clinical course, requiring a three-day hospital stay and 12-month follow-up without complications. Conclusion: minimally invasive surgery, especially laparoscopic surgery, has redefined the therapeutic standard for choledochal cysts. It is currently the treatment of choice, with clinical outcomes equivalent to or better than open surgery and a more favorable recovery.

REFERENCES

1. 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: 263-269.

2. Singham J, Yoshida EM, Scudamore CH. Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg. 2009; 52: 434-440.

3. Ten Hove A, de Meijer VE, Hulscher JBF, de Kleine RHJ. Meta-analysis of risk of developing malignancy in congenital choledochal malformation. Br J Surg. 2018; 105: 482-490.

4. Farello GA, Cerofolini A, Rebonato M, Bergamaschi G, Ferrari C, Chiappetta A. Congenital choledochal cyst: video-guided laparoscopic treatment. Surg Laparosc Endosc. 1995; 5: 354-358.

5. Yoon JH, Hwang HK, Lee WJ, Kang CM. Minimally invasive surgery for choledochal cysts: Laparoscopic versus robotic approaches. Ann Hepatobiliary Pancreat Surg. 2021; 25 (1): 71-77. doi: 10.14701/ahbps.2021.25.1.71.

6. Bloomfield GC, Nigam A, Calvo IG et al. Characteristics and malignancy rates of adult patients diagnosed with choledochal cyst in the West: a systematic review. J Gastrointest Surg. 2024; 28: 77-87. doi: 10.1016/j.gassur.2023.11.007.

7. Soares KC, Arnaoutakis DJ, Kamel I, Rastegar N, Anders R, Maithel S, Pawlik TM. Choledochal cysts: presentation, clinical differentiation, and management. J Am Coll Surg. 2014; 219: 1167-1180.

8. Narayanan SK, Chen Y, Narasimhan KL, Cohen RC. Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: a systematic review and meta-analysis. J Pediatr Surg. 2013; 48: 2336-2342.

9. Nguyen Thanh L, Hien PD, Dung le A, Son TN. Laparoscopic repair for choledochal cyst: lessons learned from 190 cases. J Pediatr Surg. 2010; 45 (3): 540-544. doi: 10.1016/j.jpedsurg.2009.08.013.

10. Shen HJ, Xu M, Zhu HY, Yang C, Li F, Li KW et al. Laparoscopic versus open surgery in children with choledochal cysts: a meta-analysis. Pediatr Surg Int. 2015; 31 (6): 529-34. doi: 10.1007/s00383-015-3705-0.

11. Ai C, Wu Y, Xie X, Wang Q, Xiang B. Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction after resection of congenital biliary dilatation: a systematic review and meta-analysis. Surg Today. 2023; 53: 1-11. doi: 10.1007/s00595-021-02425-z.

12. Lin S, Chen J, Tang K, He Y, Xu X, Xu D. Trans-umbilical Single-Site Plus One Robotic Assisted Surgery for Choledochal Cyst in Children, a Comparing to Laparoscope-Assisted Procedure. Front Pediatr. 2022; 10: 806919. doi: 10.3389/fped.2022.806919.

13. Söreide K, Körner H, Havnen J, Söreide JA. Bile duct cysts in adults. Br J Surg. 2004; 91 (12): 1538-1548. doi: 10.1002/bjs.4815.