IPEG 2020 Top Abstract: Robotic excision of type IV choledochal cyst with hepaticoduodenostomy
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More about type 4 choledochal cyst
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What the experts said
Ultrasound showed fusiform dilation of the common bile duct measuring up to 2 centimeters at the mid portion and intrahepatic ductal dilation up to 10 millimeters
MRCP showed a 2.2 centimeter common bile duct with distal narrowing at the pancreatic head and dilated intrahepatic ducts, consistent with a type 4 choledochal cyst
The cyst was divided as distally as possible on the pancreatic bed
The cyst was divided at the confluence of the hepatic ducts about 1 centimeter away from liver parenchyma
3 hepatic ducts were identified
The hepaticoduodenostomy was made using 25 interrupted 30 vicryl sutures
The articulating robotic needle drivers are especially helpful with hepaticoduodenostomy anastomosis
The patient had no postoperative complications
The patient was advanced to a general diet by postoperative day 3
The drain was pulled on postoperative day 4 and the patient was discharged home
At 1 and 6 month follow-up visits, the patient had no further issues with weight gain or abdominal pain
The decision to perform hepaticoduodenostomy to reconstruct the biliary tree is well supported in the literature
Some sources support Roux-en-Y hepaticojejunostomy as the preferred method for reconstruction due to decreased bile reflux and lower incidence of cholangitis
A meta-analysis by Narayanan et al. showed no significant difference in incidence of cholangitis between hepaticoduodenostomy and hepaticojejunostomy reconstruction
Narayanan et al. concluded that hepaticoduodenostomy is comparable to hepaticojejunostomy in terms of overall complication rate
Limb suggests that hepaticoduodenostomy is the preferred procedure due to decreased fat malabsorption, shorter operating time, and no difference in postoperative biliary leak
Silva Bayas et al. state that hepaticoduodenostomy is a safe operation to perform with few postoperative complications