title: Laparoscopic Management of Choledochal Cyst-Technical Modifications and Outcome Analysis.
abstract: BACKGROUND
  Choledochal cyst (CDC) is a well described albeit rare clinical entity. Complete cyst excision with biliary-enteric reconstruction is the recommended treatment for Todani type I, II, and IVA cysts to prevent complications. The aim of this study is to evaluate outcomes of laparoscopic CDC excision from a tertiary care center.
  
  
  METHODS
  This is a retrospective analysis of prospectively collected data of 110 patients who underwent laparoscopic cyst excision and biliary-enteric reconstruction for CDC type I and IVA from 1998 to 2013.
  
  
  RESULTS
  Out of 110 patients, 55 were children (<16 years) and 55 were adults (>16 years) with mean age 21.19 ± 17.75 years and male:female ratio of 1:2.14. Abdominal pain was the most common presenting symptom (59.09 %). Surprisingly, 32.73 % of adults presented with incidentally detected cyst. Type I cyst was the most common (71.82 %) with mean size of 4.67 ± 1.59 cm. Blood loss (56.0 ± 16.62 vs. 76.55 ± 26.61 ml) and operative time (199.8 ± 44.66 vs. 251.6 ± 54.25 min) were significantly low in pediatric group. Three adults required conversion. Overall complication rate was 10 %. Re-exploration rate was 1.81 % with one patient died post-operatively. Mean hospital stay was significantly low in children (5.9 ± 1.39 vs. 7.0 ± 2.66 days). Median follow-up was 60 months (8-110). Cholangitis developed in six patients with three having anastomotic stricture requiring intervention.
  
  
  CONCLUSIONS
  Laparoscopic excision of CDC is safe and feasible. Surgery should be performed early as outcomes are better in pediatric age as compared to adults.
authors.affiliation: Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja mills road, Ramanathapuram, Coimbatore, 641045, Tamil Nadu, India, senthilnathan94@gmail.com.
authors.forename: Palanisamy
authors.initials: P
authors.lastname: Senthilnathan
authors.forename: Nikunj D
authors.initials: ND
authors.lastname: Patel
authors.forename: Arun S
authors.initials: AS
authors.lastname: Nair
authors.forename: V P
authors.initials: VP
authors.lastname: Nalankilli
authors.forename: Anand
authors.initials: A
authors.lastname: Vijay
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D002761:Cholangitis / Q000209:etiology; D015529:Choledochal Cyst / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult