47715 Excision of choledochal cyst

Name of the Procedure:

Excision of Choledochal Cyst
Common names: Removal of bile duct cyst, Surgery for bile duct cyst

Summary

The excision of a choledochal cyst involves surgically removing an abnormal cyst from the bile duct, which is part of the digestive system. This procedure helps in preventing complications that can arise from the cyst, such as infections or even cancer.

Purpose

• Medical Condition: Treatment of choledochal cysts.
• Goals: The main goal of the procedure is to remove the cyst to prevent complications such as bile duct infections, obstructions, pancreatitis, and potential malignancy (cancer).

Indications

• Recurrent abdominal pain
• Jaundice (yellowing of the skin and eyes)
• Episodes of cholangitis (infection of the bile duct)
• Pancreatitis (inflammation of the pancreas)
• Bile duct obstruction or dilatation identified on imaging studies

Preparation

• Fasting: Usually, fasting is required for 8-12 hours before the surgery.
• Medications: Adjustments to current medications may be needed; blood thinners might need to be stopped.
• Diagnostic Tests: Blood tests, liver function tests, ultrasound, and MRCP (Magnetic Resonance Cholangiopancreatography) or ERCP (Endoscopic Retrograde Cholangiopancreatography) imaging studies.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A surgical incision is made in the abdomen.
3. Cyst Removal: The surgeon identifies and carefully removes the choledochal cyst.
4. Bile Drainage Reconstruction: The bile duct is reconstructed, often creating a new connection to the intestine (Roux-en-Y hepaticojejunostomy).
5. Closure: The incision is closed with sutures or staples.

Tools and Equipment: Surgical instruments, retractors, laparoscopes (in minimally invasive procedures), sutures, and anesthesia equipment.

Duration

The procedure typically takes around 3 to 4 hours.

Setting

It is performed in a hospital operating room.

Personnel

• Surgeon: A specialized gastrointestinal or hepatobiliary surgeon.
• Anesthesiologist: To manage anesthesia and monitor vital signs.
• Nurses and Surgical Technicians: Assist with the procedure and provide perioperative care.

Risks and Complications

• Common Risks: Infection at the incision site, bleeding, bile leakage.
• Rare Risks: Injury to nearby structures (like the liver or pancreas), strictures (narrowing) of the bile duct, and anesthesia-related complications.

Benefits

• Relief from symptoms like pain and jaundice.
• Prevention of serious complications such as cholangitis and cancer.
• Improved overall liver function and quality of life.

Recovery

• Post-Procedure Care: Pain management, antibiotics to prevent infection, possible drainage tubes.
• Recovery Time: Hospital stay of about a week; full recovery might take several weeks.
• Restrictions: Avoid heavy lifting and strenuous activities; follow dietary recommendations.
• Follow-Up: Regular follow-up appointments to monitor recovery and liver function.

Alternatives

• Non-Surgical: Endoscopic drainage (temporary measure, not typically definitive).
• Other Surgical Methods: Depending on cyst location and patient condition, variations in surgical approach may be considered.
• Pros and Cons: Excision offers a definitive cure, whereas non-surgical options generally do not and may present a higher risk of recurrence and complications.

Patient Experience

• During the Procedure: Patients will be asleep under general anesthesia and will feel no pain.
• After the Procedure: Initial post-operative pain managed with medication; some discomfort in the abdominal area is expected.
• Pain Management: Medications are provided to control pain, and patients are encouraged to move around carefully to aid recovery and prevent complications like blood clots.