Management of a choledochal cyst with a Roux-en-Y loop performed under laparoscopic control in a 3-year-old girl

This is the case of a 3-year-old girl presenting with a choledochal cyst. This video shows the management of this choledochal cyst with a Roux-en-Y loop performed under laparoscopic control. The patient is placed in a supine position. The surgeon stands between the patient's legs. Three trocars are placed: an optical trocar through the umbilicus and two 5mm trocars, one in each flank.

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Management of a choledochal cyst with a Roux-en-Y loop performed under laparoscopic control in a 3-year-old girl

Authors

Abstract

This is the case of a 3-year-old girl presenting with a choledochal cyst. This video shows the management of this choledochal cyst with a Roux-en-Y loop performed under laparoscopic control. The patient is placed in a supine position. The surgeon stands between the patient's legs. Three trocars are placed: an optical trocar through the umbilicus and two 5mm trocars, one in each flank.

Catégorie

contribution

Mots-clés

Management of choledochal cyst, Roux-en-Y loop, laparoscopic control

Type de vidéo

Vidéo chirurgicale

Durée

05'11''

Publication

2010-04

Popularité

Favoris

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Audio

Sous-titres

E-publication

WeBSurg.com, Apr 2010;10(04).
URL: http://www.websurg.com/doi-vd01en2939.htm

Management of a choledochal cyst with a Roux-en-Y loop performed under laparoscopic control in a 3-year-old girl

1. Introduction 00'13''

This is the case of a 3-year-old girl presenting with a choledochal cyst. She is placed in a supine position. The surgeon stands between the patient’s legs. Three trocars are placed: an optical trocar through the umbilicus and two 5mm trocars, one in each flank.

2. Gallbladder suspension 00'27''

The gallbladder is suspended by a stitch passed transparietally and is tied over a pledget in order not to injure the skin. The gallbladder suspension helps to avoid using a liver retractor.

3. Intraoperative cholangiography 00'39''

The first operative step consists in an intraoperative cholangiography through puncture of the gallbladder. Here the lower portion of the common bile duct is freed with the ultrasonic scalpel paying attention not to burn the duodenum.

4. Calot\'s triangle dissection and cystic duct division 00'53''

The cholecystectomy is begun with the dissection of the Calot’s triangle and division of the cystic duct between 2 clips.

5. Common hepatic duct dissection and division 01'01''

The dissection leads us to reach the common hepatic duct immediately above the choledochal cyst. The common hepatic duct is slightly dilated but not cystic. The division is performed in a normal anatomic area. Dissection is continued towards the distal portion of the choledochal cyst and the distal extremity of the intra-hepatic common bile duct is divided using the monopolar hook. This simple cauterization and division is sufficient. In this case, there is no need for a suture.

6. Preparation of Roux-en-Y loop 02'28''

The second operative step consists in the preparation of a Roux-en-Y loop. On the second jejunal loop, the proximal extremity of the mounted loop is divided with the Endo-GIA linear stapler. The mesenteric mobilization helps to reach the common hepatic duct without any tension once the mounted loop has been passed transmesocolically.

7. Jejunojejunal anastomosis 03'18''

The digestive continuity will soon be restored at the foot of the mounted loop approximately 30cm from the future bilio-digestive anastomosis. The restoration of the digestive continuity is achieved through a side-to-side anastomosis using an Endo-suture stapler, blue cartridge. A suture is placed. It aims at closing the proximal extremity of the anastomosis with a running Vicryl 3/0 suture.

8. Bilio-digestive anastomosis 04'26''

The bilio-digestive anastomosis is carried out with interrupted stitches of PDS 6/0 material once the apex of the mounted loop has been opened with the monopolar hook.

9. Completion of cholecystectomy 05'09''

At the end of the procedure, the cholecystectomy is completed with removal of the gallbladder out of its liver bed.

10. Specimen extraction 05'16''

The entire specimen including all of the accessory and main extra-hepatic bile duct is withdrawn using an extraction bag. Food intake is resumed on postoperative day 3 and the patient is discharged on postoperative day 5.