ABSTRACT
Background: The minimally invasive surgery (MIS) in GBC is being increasingly performed with superior short term results and non-inferior oncological outcomes. Most of the studies on minimally invasive radical cholecystectomy (MIRC) included patients with GBC limited to the gall bladder. Bile duct or adjacent viscera has been resected only in a very few studies. One of the reasons perhaps for not imbibing MIS in advanced GBC is the innate complexity of resection of the involved adjacent organs and need performing a bilioenteric anastomosis. Aim of this study is to assess safety, feasibility and short-term outcomes of locally advanced GBC patients who underwent MIRC with adjacent bile duct or viscera resection. Methods: Retrospective analysis of prospectively maintained data of 11 patients who underwent MIRC with adjacent viscera resection for suspected case of GBC in a single surgical unit between January 2017 to December 2019 at Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, a tertiary referral teaching institute. Results: During the study period 11 patients underwent adjacent viscera resection along with MIRC.Ten patients had Common bile duct (CBD) excision (4 choledochal cyst and 6 direct tumor infiltration), four patients had gastroduodenal resection (3 sleeve duodenectomy and 1 distal gastrectomy with proximal duodenectomy) and three patients had colonic resection (2 sleeve resection and 1 segmental resection). Seven patients had single organ resection (3 CBD and 4 CDC), 2 of them had double organ (CBD & duodenum, duodenum & colon) and 2 patients had triple organ resection (CBD, duodenum and colon). Conclusion: The minimally invasive approach inGBC patients who need extrahepatic adjacent viscera resection was found to be feasible and safe with favourable perioperative and oncological outcomes.Further studies are needed from high-volume centres engaged in minimally invasive hepatobiliary surgery.
ABSTRACT
Background: Standard treatment for choledochal cyst (CDC) is excision of cyst with biloenteric reconstruction. Most common methods of reconstruction following CDC excision are Roux en y hepaticojejunostomy (RYHJ) and Hepaticoduodenostomy (HD). Although HD has been employed in paediatric population, its use in adult patients has been limited. Aim: The aim of the study was to analyse our experience of patients who underwent laparoscopic excision of CDC and to compare the short term and long term outcomes following HD versus RYHJ as a method of reconstruction in adults. Methods: This is a retrospective analysis of prospectively collected data of 65 patients who underwent laparoscopic cyst excision from January 2016 to March 2021in a single surgical unit at GB Pant Institute of Post graduate Medical Education and Research, New Delhi. Following CDC excision HD was our preferred as method of biliary reconstruction. Patients with restricted duodenal mobility and thin friable duct underwent RYHJ.Short-term outcomes included operative time,blood loss, length of hospital stay and complications such as anastomotic leakage and post operative bleeding.Long-term outcomes included anastomotic stricture formation and need for redo biliary reconstruction. Results: Total 65 patient underwent laparoscopic CDC excision. Mean age was 31.66 ± 12.77years and male: female ratio was 1:5.4. Type I cyst was the most common (60/65=92.3%) with mean size of 2.59 ±0.78cm. Laparoscopic HD was feasible in 87% (57/65) of patients. RYHJ was done in 8 patients. Outcome in laparoscopic HD vs RYHJ group: Mean blood loss was 54.22±8.9ml vs 92±16 mL, mean operative time was 182±41.6 vs 240±52.2 mL, mean hospital stay was 4±2.1 vs 5±3.2 days. There was no difference in anastomotic leak rate (3 vs 1, p=0.42) or post-operative bleeding rate between the two groups.There was no perioperative mortality. Conclusion: Laparoscopic HD was feasible in most of the adult CDC patients with better short term and comparable long term results.It may be used as the preferred biliary reconstruction method during laparoscopic CDC excision in adults as it is technically easier, requires single anastomosis and also accessible for future endoscopic intervention.