Choledochal cyst: A 14-year surgical experience with 36 patients

Tan, K. C.; Howard, E. R.

doi:10.1002/bjs.1800750921

Cited by 58 publications

(30 citation statements)

References 31 publications

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“…The classical triad of jaundice, pain in the abdomen, and mass was present in 13 to 63 % of unselected series [11]. It is uncommon in children [12].…”

Section: Discussionmentioning

confidence: 99%

Hepaticoduodenostomy for Biliary Reconstruction After Surgical Resection of Choledochal Cyst: a 25-Year Experience

Patil

Kanetkar²,

Talpallikar

2012

Indian J Surg

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We reviewed our experience of hepaticoduodenostomy done for choledochal cyst from 1982 to 2007 at our center. The aim of the study was to evaluate the efficacy of hepaticoduodenostomy as a mode of biliary reconstruction after surgical resection of choledochal cyst, to look for any complications associated with hepaticoduodenostomy, with review of the literature. A total of 56 patients underwent hepaticoduodenostomy after surgical resection of choledochal cyst, of which 54 patients underwent primary cyst excision with hepaticoduodenostomy and 2 patients underwent redo surgery (hepaticoduodenostomy). Most of the patients had an uneventful postoperative recovery. Early complications were biliary leak in three patients which subsided on conservative treatment. Long-term complication was seen in only one patient who developed anastomotic stricture 18 years after primary resection of choledochal cyst and hepaticoduodenostomy. Hepaticoduodenostomy is a relatively safe procedure with very low complication rates. It requires a single anastomosis and is simple to perform.

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“…The classical triad of jaundice, pain in the abdomen, and mass was present in 13 to 63 % of unselected series [11]. It is uncommon in children [12].…”

Section: Discussionmentioning

confidence: 99%

Hepaticoduodenostomy for Biliary Reconstruction After Surgical Resection of Choledochal Cyst: a 25-Year Experience

Patil

Kanetkar²,

Talpallikar

2012

Indian J Surg

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“…Excision of the CDC in the presence of portal hypertension is a major and hazardous undertaking due to the presence of extensive collaterals in the hepatoduodenal ligament and may be associated with increased postoperative morbidity and mortality [33]. Cyst excision may have to be abandoned in favor of internal drainage in these patients [3, 6, 34]. Decompression of the portal venous system in the form of a portosystemic shunt may be required before the cyst can be approached for excision, especially in patients who have bled from the varices [35].…”

Section: Discussionmentioning

confidence: 99%

“…It is estimated that 13–69% of patients who have had an internal drainage procedure would need reoperation for abdominal pain, jaundice, recurrent cholangitis, calculi, pancreatitis and portal hypertension because of strictured cystenterostomy and stasis within the retained cyst [6, 34, 44, 45]. It is also estimated that the risk of malignancy in the retained cysts may be as high as 50% [15].…”

Section: Discussionmentioning

confidence: 99%

Management of Complicated Choledochal Cysts

Lal¹,

Agarwal²,

Shivhare³

et al. 2007

Dig Surg

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Objectives: The presentation of choledochal cysts (CDCs) is altered by complications such as acute severe cholangitis, hepatolithiasis, spontaneous perforation, portal hypertension, pancreatitis, malignancy of the biliary tract and previous surgery in the form of internal drainage of the cyst. The management and the outcome of such complicated cysts differ from that of an uncomplicated CDC. This presentation is an analysis of our experience with complicated CDCs. Patients and Methods: One hundred and forty-four patients with CDCs were managed at a tertiary level referral hospital in North India, between January 1989 and June 2004. Thirty-three (23%) CDCs were associated with complicating factors: severe cholangitis requiring a biliary drainage procedure prior to definitive operative procedure (n = 11), spontaneous perforation (n = 3), hepatolithiasis (n = 6), acute cholecystitis (n = 1), recurrent acute pancreatitis (n = 1), chronic pancreatitis (n = 1), gastric outlet obstruction (n = 1), portal hypertension (n = 6), biliary tract malignancy (n = 4) and previous internal drainage of the cyst (n = 5). Five patients had more than one complication. The management outcome of complicated CDCs was compared with that of uncomplicated CDCs. Results: Complicated CDCs were significantly more common with type IV-A anatomy. Endoscopic, percutaneous or external surgical biliary drainage procedure was performed in 14 complicated CDCs prior to cyst excision. Desired definitive surgical procedure could be performed in 26/33 (79%) patients with complicated CDCs as compared to 107/111 (96%) patients with uncomplicated CDCs. Four (12%) patients with complicated CDCs had early postoperative complications as compared to 9/111 (8%) patients with uncomplicated CDCs. During a median follow-up of 13 months (2 months to 8 years), 2 patients with complicated CDCs died due to advanced secondary biliary cirrhosis and advanced gall bladder cancer, respectively. Six patients reported complications. Of the 6 patients, 3 required reoperation for a strictured hepaticojejunostomy (n = 2) and hepatolithiasis (n = 1). In contrast, there was no disease-related mortality and only 1 out of 111 patients with uncomplicated cysts had a complication during follow-up. Conclusion: Complicated CDCs merit a carefully planned management strategy including percutaneous, endoscopic and surgical procedures. The management may have to be staged. The outcome depends on the nature of complication and the management strategy adopted.

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“…About 3,000 cases have been reported in the literature thus far, with a higher female prevalence (female/male: 3/1) [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

The Discovery of a Choledochal Cyst During a Single-Port Cholecystectomy With Intra-Operative Cholangiogram

Rossetti

2013

J Med Cases

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Choledochal cyst is a rare congenital malformation, which is most often discovered in pediatric patients. Perioperative cholangiography is routinely performed in our institution during standard or single-port cholecystectomies. We report the case of a 25 yearold woman with a choledochal cyst identified during a single-port cholecystectomy with cholangiogram. The case illustrates the feasibility and usefulness of single-port intra-operative cholangiogram.

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Choledochal cyst: A 14-year surgical experience with 36 patients

Cited by 58 publications

References 31 publications

Hepaticoduodenostomy for Biliary Reconstruction After Surgical Resection of Choledochal Cyst: a 25-Year Experience

Hepaticoduodenostomy for Biliary Reconstruction After Surgical Resection of Choledochal Cyst: a 25-Year Experience

Management of Complicated Choledochal Cysts

The Discovery of a Choledochal Cyst During a Single-Port Cholecystectomy With Intra-Operative Cholangiogram

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