Choledochal cysts : A review of literature

Bhavsar, Mahendra S; Vora, Hasmukh B; Giriyappa, Venugopal H.

doi:10.4103/1319-3767.98425

Cited by 81 publications

(111 citation statements)

References 43 publications

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“…4 , 5 Modern imaging techniques have facilitated the diagnosis of choledochal cyst at any time from antenatal to adult life. 6 Symptoms of choledochal cyst include abdominal pain, jaundice, cholangitis, and may eventually lead to malignant transformations, so early diagnosis and proper surgical excision are very important. For many years, open excision, as the standard procedure, made great impact in the treatment of choledochal cyst.…”

mentioning

confidence: 99%

Laparoscopic Excision Versus Open Excision for the Treatment of Choledochal Cysts: A Systematic Review and Meta-Analysis

Chen

Xia

et al. 2015

International Surgery

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In 1723, Vater first described choledochal cyst and in 1977, Todani et al classified this disease. For many years, open excision (OP) as the standard procedure made a great impact in the treatment of choledochal cyst. Since 1995, when Farello et al first reported laparoscopic choledochal cyst excision, laparoscopic excision (LA) has been used worldwide. However, its safety remains a major concern. The aim of this meta-analysis was to compare OP with LA in treating choledochal cyst and then to determine whether LA is safe and valid. The design of this study involved systematic review and meta-analysis. Data sources were Medline, Ovid, Elsevier, Google Scholar, Embase, and Cochrane library. The study selection entailed comparative cohort studies. For data extraction, 2 investigators independently assessed selected studies and extracted the following information: study characteristics, quality, outcomes data, etc. For the results, 7 comparative cohort studies about the effectiveness of LA compared with OP were performed meta-analysis. The results showed that although the LA group had a longer operative time (MD = 56.57; 95% CI = 32.20–80.93; P < 0.00001), LA had a shorter duration of hospital stay (MD = −1.93; 95% CI = −2.51 to −1.36; P < 0.00001), and recovery of bowel function (MD = −0.94; 95% CI = −1.33 to −0.55; P < 0.00001). Meta-analysis found no significant difference between most of the 2 groups: bile leak (RR = 0.60; 95% CI = 0.29–1.24; P = 0.17), abdominal bleeding (RR = 0.33; 95% CI = 0.01–8.98; P = 0.51), pancreatitis (RR = 0.26, 95% CI = 0.06–1.03; P = 0.06), total postoperative complications (RR = 1.04; 95% CI = 0.66–1.62; P = 0.88). The LA group had significant lower rates in intraoperative blood transfusion (RR = 0.20; 95% CI = 0.11–0.38; P < 0.00001), and adhesive intestinal obstruction (RR = 0.17, 95% CI = 0.04–0.77; P = 0.02). In conclusion, compared with open excision, laparoscopic excision is a safe, valid, and feasible alternative to open excision.

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confidence: 99%

Laparoscopic Excision Versus Open Excision for the Treatment of Choledochal Cysts: A Systematic Review and Meta-Analysis

Chen

Xia

et al. 2015

International Surgery

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“…Pancreatic secretions will be forced into this space due to the presence of the anomalous pancreatobiliary junction. [2] Backflow of intestinal secretions results in the activation of pancreatic enzymes in the remnant cyst, which may lead to infection, stone formation, and an increased risk of malignancy. [20] A previous study demonstrated that no patients developed cholangiocarcinoma after complete cyst excision.…”

Section: Discussionmentioning

confidence: 99%

“…[1] Presence of an anomalous junction of the pancreaticobiliary duct that allows pancreatic secretions to reflux into the biliary tree is the generally accepted etiopathogenic theory of these cysts. [2,3] Nearly 20% of choledochal cysts are present in adults, and malignant transformation is the most feared complication. [4] A 6% to 30% risk of developing malignancy is estimated in patients with choledochal cysts; the risk is low in childhood (<1%) but increases to about 30% to 40% with age greater than 50 years.…”

Section: Introductionmentioning

confidence: 99%

The distal classification and management of choledochal cyst in adults

Liu

Sun²,

Guo³

et al. 2017

Medicine

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Todani classification is extensively used to guide the surgical strategy of choledochal cysts, but no systematic investigations on the distal management of intrapancreatic choledochal cysts have been conducted. This study reports the distal classification and management of choledochal cysts in adults based on the relation between the cyst and pancreatic duct. Patients with choledochal cyst who underwent operation, including distal management, in our department from January 2009 to December 2014 were retrospectively reviewed. Patients presenting symptoms, coexisting diseases, surgical treatment, perioperative complications, and long-term follow-up according to the distal classification of choledochal cyst were analyzed. A total of 54 patients with choledochal cyst were included in the present retrospective study. Based on the distal classification of choledochal cyst, 39 patients (72.22%) were type 1, 13 patients (24.07%) were type 2, and 2 patients (3.70%) were type 3. Thirty-nine type 1 patients and 10 type 2 patients underwent excision of intrapancreatic choledochal cyst or bile duct. Three type 2 patients received excision of distal cylindrical cyst and papilla, followed by pancreatic duct plasty with duodenum mucosa. One type 3 patient underwent endoscopic sphincteroplasty, and another type 3 patient underwent transduodenal sphincteroplasty. After the operation, 11 patients (20.37%, 11/54) had short-term perioperative complications. The long-term follow-up results showed that the satisfactory rate (excellent and good outcomes) was 95.83%. Current distal classification of choledochal cysts could provide a more targeted strategy for complete excision to eliminate potential dead space within the pancreas, protect the pancreatic duct, and prevent reoperation.

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“…En effet, la régénération continue de l´épithélium biliaire dénudé évolue au long court vers la métaplasie intestinale puis vers la dysplasie. Des études anatomo-pathologiques ont pu mettre en évidence des lésions hyperplasiques, dysplasiques, et carcinomes in situ disséminés illustrant l´hypothèse d´un continuum évolutif vers un stade invasif [ 11 , 12 ]. Le cas de dégénérescence que nous rapportons pourrait bien être inclus dans ce cadre là; des zones de dysplasie modérées et sévères, à différents sites de la dilatation, étaient associés à une lésion tumorale qui du reste ne dépassait pas la musculeuse.…”

Section: Discussionunclassified

“…L´adénocarcinome est le type histologique le plus fréquent (90% des cas); des formes mixtes avec des zones d´hépithéliomas malpighiens ne sont pas rares [ 2 ]. Le type papillaire aurait le meilleur pronostic [ 12 ]. Sur le plan clinique, aucun signe d´appel n´est particulier au cancer développé sur DKVB [ 3 ].…”

Section: Discussionunclassified

Cancer développé sur dilatation kystique de la voie biliaire: à propos d’un cas

Soufi¹,

Lahlou²,

Chad³

2014

Pan Afr Med J

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Les auteurs rapportent un cas de dilatation kystique du cholédoque intra- pancréatique découvert chez une femme de 46 ans et compliqué d'un carcinome tubulo-papillaire n'envahissant pas le pancréas. Le traitement a consisté en une duodénopancréatectomie céphalique avec un curage ganglionnaire et anastomose hépatico-jéjunale; la survie était de 30 mois; les auteurs abordent les aspects radiologiques, anatomopathologiques, thérapeutiques et pronostiques de ces cancers développé sur dilatation kystique de la voie biliaire et discutent la place d'une radiothérapie complémentaire de la chirurgie susceptible d'améliorer la survie.

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Choledochal cysts : A review of literature

Cited by 81 publications

References 43 publications

Laparoscopic Excision Versus Open Excision for the Treatment of Choledochal Cysts: A Systematic Review and Meta-Analysis

Laparoscopic Excision Versus Open Excision for the Treatment of Choledochal Cysts: A Systematic Review and Meta-Analysis

The distal classification and management of choledochal cyst in adults

Cancer développé sur dilatation kystique de la voie biliaire: à propos d’un cas

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