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Jessica Zagory, MD
@jessicazagory @MarkLikesTrauma @samir_pandya_md @UTSW_Surgery

Jessica Zagory, MD; Mark Ryan, MD; Samir Pandya, MD; UT Southwestern Medical Center

Clinical History: This is a 4-year-old female who initially presented with epigastric abdominal pain and nonbilious emesis. After an inconclusive ultrasound to evaluate for appendicitis, a CT scan was obtained, which demonstrated pancreatic inflammation and a cystic structure within the porta hepatis. The initial lipase level was 6000. An MRCP was then performed, which showed a type 1 choledochal cyst measuring 4.2 cm in diameter. Following resolution of her pancreatitis, she was brought to the operating room two months later for laparoscopic resection of the choledochal cyst.

Operative Technique: Since the primary surgeon was left-handed, we chose a right lateral approach for port placement. We utilized a four-port technique with 5 mm short instruments, a 5 mm vessel sealing device, and a 5 mm stapler. Intraoperatively, an accessory hepatic duct was noted originating from the right posterolateral portion of the cyst. This was sutured intracorporeally to the proximal common hepatic duct to construct a common channel. The hepaticoduodenostomy was performed from the patient’s right side, suturing primarily with the left hand.

Hospital Course: The patient experienced an uneventful recovery. She was started on a regular diet on postoperative day 4. She did not experience postoperative jaundice and bowel movements were normal in appearance. She was discharged on postoperative day 6. Pathology for the specimen was consistent with a choledochal cyst. No subsequent issues were noted at follow up 3 months after discharge.

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