Choledochal cyst: A review of 79 cases and the role of hepaticodochoduodenostomy (original) (raw)
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Journal of Laparoendoscopic & Advanced Surgical Techniques, 2009
Objective: To report the technical details and early outcomes of complete laparoscopic cyst excision and hepaticoduodenostomy for choledochal cyst. Methods: The operation was performed using four ports. The cystic duct was identified and divided. The liver was elevated by two stay sutures: one on the round ligament, and the other on the distal cystic duct. The choledochal cyst was isolated and removed completely and the duodenum was mobilized. Hepaticoduodenostomy was constructed 2 cm distal to the pylorus using two running sutures with 5-0 polydioxane sutures. Results: From January to December 2007, 74 patients were operated. There were 59 girls and 15 boys. Ages ranged from 2.5 months to 16 years old. The diameter of the cyst ranged from 10 mm to 184 mm. The operating time ranged from 90 minutes to 340 minutes (mean: 186 minutes). Conversion to open surgery was required in one patient. Blood transfusion was required in four patients. Postoperative anastomotic leakage occurred in three patients, resolving spontaneously in two patients and requiring a second operation in the third. Postoperative hospital stay ranged from 4 days to 21 days (average: 6.6 days). Follow-up from 3 months to 12 months was obtained in 56 patients (75.5%). Of these patients, cholangitis occurred in three patients (5.3%) and gastritis due to bilious reflux in eight patients (14.3%). Conclusion: Laparoscopic complete cyst excision and hepaticoduodenostomy is a safe and physiologic procedure for choledochal cyst.
Choledochal cyst: a 10-year experience
Jornal de Pediatria, 2000
Objective: to assess the outcome of surgical treatment of choledochal cyst in patients within a 10-year period. Methods: retrospective review of medical records of 18 patients submitted to surgical treatment of choledochal cyst. Results: eighteen patients aged 20 days to 13 years, 15 (83%) female and 3 (17%) male. Initial symptoms: 15 (83%) patients presented with jaundice, 11 (61%) with dark urine, 10 (55%) with acholic feces, 9 (50%) with abdominal pain, and 2 (11%) with abdominal mass. Fourteen (77%) patients were diagnosed by sonography of the abdomen. Endoscopic retrograde cholangiopancreatography was carried out in four patients, and indicated an abnormal common hepatic duct in three of them. Nine patients presented type I, one presented type II, seven presented type IV, and one presented type V cysts. All patients, with the exception of the patient with type V cyst, were submitted to cyst excision with Roux-en-Y hepaticojejunostomy. Two (11%) postoperative deaths were recorded due to complications related to the deterioration of hepatic function. Out of the 15 patients who were submitted to long-term follow-up, two (14%) presented chronic pancreatitis, and 13 (86%) were free of symptoms, without any evidence of late complications.
Complete Laparoscopic Management of Choledochal Cyst: Report of Two Cases
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2002
Background: Choledochal cyst is a rare congenital anomaly of the biliary tract. With increased familiarity with the laparoscopic anatomy of the biliary tract and advances in minimally invasive techniques, surgeons have ventured further to operate on technically difficult cases such as choledochal cyst that were until recently managed by laparotomy. Patients and Methods: We present our experience with two female patients aged 14 years and 26 years with choledochal cyst (type I according to the Alonzo-Lej classification) that were successfully excised with construction of a Roux-en-Y hepaticojejunostomy entirely laparoscopically. Results: Both patients had an uneventful recovery, with no major morbidity. The first patient had a bile leak, which resolved over 5 days. Both were discharged by the 5 th postoperative day. Conclusion: Laparoscopic management of choledochal cyst is feasible although technically difficult and may be performed in specialized institutes dealing with advanced laparoscopic surgery.
Journal of the Pakistan Medical Association
Choledochal Cyst (CC), also known as the biliary cyst, is one of the rare inherited anomalies of intrahepatic and/or extrahepatic biliary system characterised by varying degrees of cystic dilatation of the biliary tract without acute obstruction. The prevalence ranges from 1 in 13,000 people to 1 in 2 million people with preponderance in Asia (1), particularly in Japan. Moreover, the presentation also varies in children and adults, and is usually vaguer and non-specific in adults. The prevalence is even lower in males, with female to male ratio being 3:1-4:1 (2). We present here three cases of adult choledochal cysts excised in our surgical unit in the last five years. We discuss the aetiopathogenesis, presentation, diagnosis, surgical treatment, and complications of choledochal cysts based on the available literature. ---Continue
Management of choledochal cyst
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2007
BACKGROUND: Choledochal cysts are rare diseases in adults. The risk of malignant transformation is well documented to be age-related and early complete cyst excision is currently advocated. Type IVa cyst management is more controversial. Extensive intrahepatic involvement of the biliary system may preclude complete excision. AIM: The aim of this study was to present a case of type IVa choledochal cyst in a young female patient. CASE REPORT: An 18-year-old female, complaining of right upper quadrant pain, nausea, vomiting, fever, and jaundice was admitted. The diagnosis of type IVa choledochal cyst was made by computerized tomography. The patient was underwent cholecystectomy, excision of the anterior wall of the cyst, and Roux-en-Y hepaticojejunostomy. No postoperative complication was noted and the patient was discharged five days after operation. CONCLUSION: Total cyst excision is the ideal treatment of choledochal cysts in adults. However, in IVa type, due to the extensive intrah...
Diagnosis and Management of Choledochal Cyst : A Single Center Experience
2019
Objective: Choledochal cyst is cystic dilatation of intrahepatic and/ or extrahepatic bile duct. Its incidence is 1 in 1000 in Asian population. The objective of the study was to study the presentation, diagnosis, treatment and postoperative outcome of choledochal cyst operated in Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal. Methods: This retrospective study was done by reviewing all the records of patients with choledochal cyst who underwent operative treatment in Dhulikhel Hospital from January 2015 to July 2019. Results: We analyzed twenty cases of Choledochal cyst. It was found to be common in age group (21-30 ) years with female preponderance (85%). Most common presenting symptom was abdominal pain. Abdominal Ultrasonography was the initial diagnostic tool. Todani type I choledochal cyst was the commonest type. All the cases underwent complete excision of extrahepatic biliary treefollowed by hepato-jejunostomy. There was no post-operative anastomosis str...
Retrospective Study of Choledochal Cyst : Clinical Presentation , Diagnosis and Treatment
2014
Choledochal cyst is a rare congenital anomaly lead to dilatation of intrahepatic or extrahepatic bile duct or both. Much about etiology, pathophysiology and natural course of the disease are still on debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. Here we have analyzed 30 operated cases of cc in our KEM hospital. We found most common age group of presentation of cc in adult is 32yr-41yr with female preponderance. Most common presenting symptom is pain. Though various radiological modalities were used to diagnose it but MRCP is most sensitive and specific for cc. In our series type I cc is most common occurrence of (63.33%). Out of 30 patients, one had developed cholangiocarcinoma and Whipples procedure was done. All other patients had undergone roux.en y hepaticojejunostomy with cyst excision without any major complication. One mortality due to malignancy. So in view of risk of malignancy early...
Management of adult choledochal cysts – a 15-year experience
HPB: Official Journal of The International Hepato Pancreato Biliary Association, 2006
Background. Choledochal cyst, a common surgical problem of childhood, can have a delayed presentation in adults. The clinical course in adults differs from that in children because of a higher incidence of associated hepatobiliary pathology. Methods. The clinical data of 57 adults with choledochal cyst managed in a general surgical unit between January 1988 and March 2003 were analysed. Results. The male:female ratio was 1:1.38 and the mean age was 34.5 years; 71.9% of the cysts belonged to Todani type I, 26.3% to type IV and 1.8% to type V. Abdominal pain and recurrent cholangitis were the commonest presentations followed by acute pancreatitis, palpable mass and bronchobiliary fistula. Anomalous pancreaticobiliary ductal junction was demonstrated in 14% of the cases. In all, 37% of the patients had undergone either wrong or suboptimal surgical procedures prior to presentation. All patients underwent complete excision of the cyst and hepaticojejunostomy. Two patients required cholangiojejunostomy and three patients required resection of the involved segments of the liver in addition. There were three anastomotic leaks and two postoperative deaths. Two anastomotic leaks resolved spontaneously while the third required surgical intervention. Forty-eight patients were available for follow-up and have remained symptom-free over a mean period of 17.6 months. Conclusions. Choledochal cyst should be considered in all patients below 40 years of age presenting with biliary colic, pancreatitis or recurrent cholangitis with associated dilatation of bile duct. Complete excision of the cyst with restoration of biliary Áenteric communication by hepaticojejunostomy form the basis of ideal treatment.
Surgical management of adult choledochal cysts
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005
Results of the surgical management of 17 choledochal cysts in adults at the Department of Surgery, Siriraj Hospital, Mahidol University, are presented All the patients who underwent diagnosis and were surgically managed during the period between October 1990 and January 1999 were analyzed retrospectively. Cysts were classified anatomically according to the descriptions of Todani et al. The authors assessed the clinical features, operative procedure and outcome of the patients. There were 15 females and 2 males, with ages ranging from 16-45 years. Only 2 patients (11.8%) had the clinical triad: jaundice, abdominal pain and mass. Clinical pancreatitis was presented in 3 patients (17.6%). There were 10 type 1 (58.8%), 6 type IVa (35.3%) and one type V (5.9%) according to Todanis classification. Cholangiocarcinoma was found in one patient (5.9%). Extrahepatic cyst excision with a Roux-en-Y hepatico-jejunostomy was performed on 16 patients with type I or IVa cysts (94.1%). There were no ...