Late Results in the Management of Choledochal Cysts

Abstract

From 1971 to 1990, 18 children were surgically managed for choledochal cysts at two Berlin pediatric surgical units. Eight patients underwent an internal drainage procedure, eight a Roux-en-Y hepaticojejunostomy and one a choledochoplasty. The children were followed-up 2 to 20 years later (median: 8.4 years). Three children died in the early postoperative period, but the immediate postoperative course was uneventful in all other cases. Later, five patients suffered from recurrent gastrointestinal disease, cholangitis and pancreatitis and, in two cases, from progressive liver fibrosis. Four of the five patients with symptoms had undergone internal drainage procedures; one developed cholangitis after a hepaticojejunostomy. In one case of internal drainage, the anastomosis was transformed into a hepaticojejunostomy. No patient had cancer.

Choledochal cysts in adults and their complications

“…The high association with APBJ in children emphasises the potential association, but the lesser frequency with which it is observed in adults suggests other aetiological factors in this patient group. The other anomalies identified at operation or during investigation were also strongly associated with choledochal cyst [14].…”

“…Several reports have documented long‐term complications following the paediatric management of choledochal cysts using cystenterostomy without total cyst excision [8, 11, 12]. Many centres now see an increasing number of adult patients who have either had previous operative procedures (without cyst excision) or experience ongoing complications related to a cyst in situ [7, 13–16]; up to 80% experience recurrent cholangitis and pancreatitis.…”

A review of choledochal cyst in pediatric and adult patients

“…It is now well established that complete cyst excision with hepatico‐enterostomy is the treatment of choice. Internal drainage operations should not be performed, as they have been shown to be associated with serious complications 9,. In the technique that we have practiced, complete excision of the cyst has been achieved, even in patients with previous infection, without the need for mucosectomy or other procedures to facilitate distal dissection.…”

Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Management of Choledochal Cysts

“…Complete cyst excision and Roux-en-Y hepaticojejunostomy are recommended as the treatment of choice for adults to prevent pancreatitis and possibly to reduce the risk of malignancy (1,5,20,36). The disadvantages of cyst excision are prolonged operating time and the risk of injury to the hepatic artery, portal vein or pancreatic duct (13).…”

“…It is accepted that management of the choledochal cysts is surgical although the type of surgery has beeen contriversial (1,2,14,20,23,(34)(35)(36)(37). Complete cyst excision and Roux-en-Y hepaticojejunostomy are recommended as the treatment of choice for adults to prevent pancreatitis and possibly to reduce the risk of malignancy (1,5,20,36).…”