Hepaticoenterostomy after excision of choledochal cyst in children: A 30-year experience with 180 cases

Miyano, Takeshi; Yamataka, Atsuyuki; Kato, Yoshifumi; Segawa, Osamu; Lane, Geoffrey J.; Takamizawa, Satoshi; Kohno, Sumio; Fujiwara, Toshio

doi:10.1016/s0022-3468(96)90843-x

Cited by 126 publications

(67 citation statements)

References 14 publications

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“…4 Typically, there is a sharp demarcation between the cyst and distal CBD lying behind head of pancreas, which then runs into a common pancreatobiliary channel (> 90%). Unless obstructed, the proximal common hepatic duct (CHD) and gallbladder are relatively normal.…”

Section: Common Types Of Choledochal Malformation Type 1cmentioning

confidence: 99%

Congenital Choledochal Malformation: Not Just a Problem for Children

Dabbas

Davenport

2009

annals

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Choledochal cysts remain relatively uncommon in Western Europe and the US, although they are appreciably more common in Asia. Their aetiology remains obscure although abnormalities of the pancreaticobiliary junction may be the primary pathology in some, with biliary dilatation following reflux of activated pancreatic secretions. Most anomalies will present in childhood with obstructive jaundice or abdominal pain; a proportion may only present for the first time during adulthood, and some of these will show malignant transformation. The classical triad of pain, jaundice and a palpable mass is, however, not common. Complete cyst excision, where possible, and biliary reconstruction remain the aims for most types although there is still some controversy about the type of reconstruction. Laparoscopic reconstruction is possible but is still very much an advanced technique. The risk of long-term problems post-surgery is significant. Whether this is due to recurrent pancreatitis secondary to the retained common channel and/or a distal stump, or due to the development of biliary tract malignancy is still a cause for concern and indicates the need for adequate, prolonged follow-up.

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Section: Common Types Of Choledochal Malformation Type 1cmentioning

confidence: 99%

Congenital Choledochal Malformation: Not Just a Problem for Children

Dabbas

Davenport

2009

annals

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“…Postoperative monitoring demonstrated that the mortality rate was 6.6%, two patients with type V cysts, a higher incidence than that of Miyano et al 25 , with zero mortality in a analysis of 180 cases in 30 years, and of Hung et al 17 , also without mortality in a group of 25 patients followed for 20 years. Those authors do not report on their analyses the individuals affected by Caroli's disease, which usually evolve into irreversible liver failure, when resection of the affected segment or liver transplantation are not possible 26 .…”

Section: Results Results Results Resultsmentioning

confidence: 69%

Choledochal cyst in childhood: review of 30 cases

Forny

Ferrante

Silveira

et al. 2014

Rev. Col. Bras. Cir.

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We observed a marked female predominance (73.4% of cases), the diagnosis being made in the first decade of life in 90% of patients. The most prevalent clinical manifestation was jaundice (70% of cases) and the classic triad of choledochal cyst was not observed. Abdominal ultrasound was the first imaging examination performed, with a sensitivity of 56.6%, with diagnostic definition in 17 children. Two patients (6.6%) had prenatal diagnosis. All patients underwent surgical treatment, cyst resection with Roux-en-Y hepaticojejunostomy being performed in 80% of cases. The incidence of postoperative complications was 13.3% and the mortality rate was 6.6%, ie two patients were diagnosed with Caroli's disease. ConclusionConclusion Conclusion Conclusion Conclusion: The non-observance of the classic triad of choledochal cyst suggests that its incidence is lower than that reported in the medical literature. The surgical treatment of choledochal cysts, with resection and bilioenteric anastomosis, is safe even for small children.

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“…However, even hepaticojejunostomy, which successfully solves the problem of extrahepatic biliary obstruction, in 7%-38% of patients can result in anastomotic strictures which require subsequent percutaneous, transhepatic or endoscopic dilation. Further complications include ascending colonization of normally sterile bile ducts by enteral Escherichia coli bacteria, which leads to recurrent cholangitis, biliary lithiasis, pancreatitis, liver failure and cholangiocarcinoma (in 9%-28% of cases 7 ), or even the formation of peptic ulcers [7][8][9][10][11][12] .…”

Section: Discussionmentioning

confidence: 99%

What is the Right Therapeutic Approach to Biliary Choledochal Cyst?

Marušić

Dominković²,

Halle

et al. 2017

acc

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SUMMARY -We report a case of biliary cyst type II which, independently of its a priori benign nature, caused numerous complications such as recurrent cholangitis and pancreatitis, as well as subsequent hepatic fi brosis and the potential danger of choledochocele perforation. Although they are benign, biliary/choledochal cysts can cause numerous disorders such as cholestasis, leading to cholangitis and pancreatitis and biliary sepsis, and due to chronic infl ammation of the biliary system even cholangiocarcinogenesis. Our fi ndings showed that sometimes this type of biliary cyst (according to the available literature the rarest and most benign type), as well as type I cyst, should undergo timely radical excision. In our patient, timely choledochocele resection would have certainly contributed to the reduction of subsequent complications, as well as to obviating repeated invasive diagnostic and surgical procedures.

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Hepaticoenterostomy after excision of choledochal cyst in children: A 30-year experience with 180 cases

Cited by 126 publications

References 14 publications

Congenital Choledochal Malformation: Not Just a Problem for Children

Congenital Choledochal Malformation: Not Just a Problem for Children

Choledochal cyst in childhood: review of 30 cases

What is the Right Therapeutic Approach to Biliary Choledochal Cyst?

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