A case series on laparoscopic management of choledochal cyst in adults at a tertiary care centre

Choledochal cysts represent a rare congenital anomaly characterized by the cystic dilation of the biliary tract. Although a vast majority of the cases present in early childhood, sometimes these cases can present in adulthood as well. The preferred treatment involves laparoscopic complete excision of the choledochal cyst with subsequent reconstruction of the biliary tract. While laparoscopic hepaticoduodenostomy is a documented procedure in the literature, laparoscopic Roux-en-Y hepaticojejunostomy has gained widespread acceptance. This study details a series of fifteen cases illustrating our experiences with these procedures. Between August 2022 and February 2024, a total of eighteen patients, including fifteen females and three males, were diagnosed with choledochal cysts. Fifteen of the patients underwent laparoscopic cyst excision with Roux-en-Y hepaticojejunostomy. Evaluation parameters included age, sex, clinical symptoms, Todani classification, operative time, complications, and hospital stay. Assessment utilized clinical history, ultrasonography, and magnetic resonance cholangiopancreatography. Out of the total eighteen cases, fifteen patients were operated, two patient developed right-sided pleural effusion which was managed with chest physiotherapy and incentive spirometry. Anastomotic leak was observed in the case of two patients which was managed conservatively. Of these patients, three developed fevers, which were managed using intravenous antipyretic drugs. In a further 3 months follow-up, no new complications were observed in any of the cases. Laparoscopic management of choledochal cysts is increasingly favoured, providing patients with the benefits of minimally invasive surgery. However, such procedures must be performed by highly experienced laparoscopic surgeons.