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Introduction <p>Laparoscopic excision of giant (&gt; 10&#xa0;cm) choledochal cyst (CDC) is found to be more challenging as compared to the open approach due to intraoperative difficulties.</p> Case presentation <p>This&#xa0;series was a retrospective study conducted from 2019 to 2023. Eight patients with giant CDC were included&#xa0;and followed up till 6&#xa0;months. The majority of children had type-IV CDC with a diameter of 15 ± 2.4&#xa0;cm. The mean operative time observed was 360 ± 64.14&#xa0;m.&#xa0;The challenges experienced by the surgeon during surgery were excessive microvascular bleeding,&#xa0;aberrant right hepatic duct, the identification of the cystic duct, narrow working space, and the distorted anatomical planes. The bleeding was controlled by topical adrenaline and dissection was started from lateral to posterior plane. The cyst was not aspirated initially which helped us in separating the surrounding structure while the retraction sutures made the identification of cystic duct easier.</p> Conclusion <p>Giant choledochal cyst is a very rare pathology of the biliary tract and its management is surgical. Due to inflammatory changes and surrounding adhesions, the resection of cysts is challenging and requires experience-based insight and technical skills. Laparoscopic excision of giant choledochal cysts and hepaticojejunostomy remains safe and doable, and should be performed by an experienced and skilled laparoscopic surgeon in a well—resourced hospital.</p>

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Challenges of laparoscopic roux-en-y hepaticojejunostomy in a case series of children with giant choledochal cyst: lessons learned

  • 期刊论文

  • 发表日期：

    2025年8月4日

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  • Muhammad Anwar,
  • Muniba Mehmood,
  • Huma Sardar,
  • Muhammad Haris Patel,
  • Rabbia Shaikh

摘要

Introduction

Laparoscopic excision of giant (> 10 cm) choledochal cyst (CDC) is found to be more challenging as compared to the open approach due to intraoperative difficulties.

Case presentation

This series was a retrospective study conducted from 2019 to 2023. Eight patients with giant CDC were included and followed up till 6 months. The majority of children had type-IV CDC with a diameter of 15 ± 2.4 cm. The mean operative time observed was 360 ± 64.14 m. The challenges experienced by the surgeon during surgery were excessive microvascular bleeding, aberrant right hepatic duct, the identification of the cystic duct, narrow working space, and the distorted anatomical planes. The bleeding was controlled by topical adrenaline and dissection was started from lateral to posterior plane. The cyst was not aspirated initially which helped us in separating the surrounding structure while the retraction sutures made the identification of cystic duct easier.

Conclusion

Giant choledochal cyst is a very rare pathology of the biliary tract and its management is surgical. Due to inflammatory changes and surrounding adhesions, the resection of cysts is challenging and requires experience-based insight and technical skills. Laparoscopic excision of giant choledochal cysts and hepaticojejunostomy remains safe and doable, and should be performed by an experienced and skilled laparoscopic surgeon in a well—resourced hospital.