Laparoscopic hepaticojejunostomy for benign disease of CBD
Chowbey, P.K. (2002) Laparoscopic hepaticojejunostomy for benign disease of CBD. In: Congress of Endoscopic and Laparoscopic Surgeons of Asia, 2002 [ELSA 2002], 19-21 Sep 2002, Tokyo, Japan.
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Management of choledochal cyst comprises excision of the cyst with a biliary enteric reconstruction. The procedure requires a certain level of technical expertise even in open surgery as the area of dissection involves the portal vein and hepatic artery. The patient population primarily involves children and adolescents. The degree of difficulty increases with increasing age of presentation and history of recurrent attack of cholangitis as adhesions between the cyst and portal vein, increase with each attack of inflammation. The procedure is well suited for a total minimal access approach as the laparoscopist is well versed with the biliary anatomy and the procedure does not involve any large / solid organ removal. The only drawbacks are the high degree of technical expertise required for dissection and anastomosis. Not much difference has been observed in the time taken for either open or minimal access approach. We, in our department have performed 5 such procedures on patients with age ranging from 5 years to 26 years. The total time taken was 280 + 40 min. The average hospital stay was 4 days, with oral resumption on day two of surgery. Bile was observed in the drain of four patients with biliary drains lasting from 24 hours to two weeks. Follow up maintained with all five patients is from 2-1/2 years to 2 months with all five patients doing well.
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