Congenital choledochal cysts in adults: twenty-five-year experience

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Author:
LIU Ying-bin(Department of Surgery,Second Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,China)
CAO Li-ping(Department of Surgery,Second Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,China)
PENG Shu-you(Department of Surgery,Second Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,China)
WANG Jian-wei(Department of Oncological Surgery, Second Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,China)
Khagendra Raj Devkota(Department of Oncological Surgery, Second Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,China)
JI Zhen-ling(Department of Surgery, Affiliated Puji Hospital of Yangzhou University, Taizhou 225300, China)
LI Jiang-tao(Department of Surgery,Second Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,China)
WANG Xu-an(Department of Surgery,Second Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,China)
MA Xiao-ming(Department of Surgery,Second Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,China)
CAI Wei-long(Department of Surgery,Second Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,China)
KONG Ying(Department of Surgery,Second Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,China)
Journal Title:
CHINESE MEDICAL JOURNAL
Issue:
Volume 120, Issue 16, 2007
DOI:
Key Word:
congenital choledochal cyst; hepaticojejunostomy; liver transplantation

Abstract: Background Choledochal cyst is rare in western countries. The relatively high incidence of coexistent hepatobiliary disease increases the difficulty of the surgical management of choledochal cyst. Here we analyze the diagnosis and treatment of congenital bile duct cyst in 122 Chinese adults.Methods The clinical data of 122 patients with congenital choledochal cysts admitted from 1981 to 2006 were analyzed.Results Clinical symptoms in most cases were nonspecific, resulting in delayed diagnosis. Sixty-one patients (50%) had coexistent pancreatobiliary disease. Among the 122 patients, 119 patients underwent ultrasonic examination;ERCP/MRCP was performed in 63 cases and CT in 102 cases. Abnormal pancreatobiliary duct junction was found in 48 patients. Sixteen patients had malignant lesions in the bile duct, arising in 11 of them from incomplete choledochal cyst that underwent various operations including cystenterostomy or cystojejunostomy. There was significant difference between the patients who underwent incomplete cyst resection and complete cyst resection in malignancy rate of bile duct (Chi square test, P= 0.000; odds ratio, 7.800; 95 % confidence interval, 2.450 to 24.836).Conclusions ERCP, CT and MRCP had proved their great values in the classification of the disease. Cyst excision with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice for patients with type Ⅰ or type Ⅳ cysts. For type Ⅴ cyst (Caroli's disease) with recurrent cholangitis, liver transplantation should be considered.

  • [1]Yamaguchi M.Congenital choledochal cyst.Analysis of 1433 patients in the Japanese literature.Am J Surg 1980; 140:653-657.
  • [2]Hewitt PM,Krige JE,Bornman PC,Terblanche J.Choledochal cysts in adults.Br J Surg 1995; 82:382-385.
  • [3]Flanigan DP.Biliary carcinoma associated with biliary cysts.Cancer 1977; 40:880-883.
  • [4]Todani T,Watanabe Y,Narusue M,Tabuchi K,Okajima K.Congenital bile dust cysts.Classification,operative procedures,and review of thirty-seven cases including cancer arising from choledochal cyst.Am J Surg 1977; 134:263 -269.
  • [5]Liu CL,Fan ST,Lo CM,Lam CM,Poon RT,Wong J.Choledochal cysts in adults.Arch Surg 2002; 137:465-468.
  • [6]Nakagohri T,Konishi M,Inoue K,Takahashi S,Tanizawa Y,Kinoshita T.Inferior head resection of the pancreas and cyst resection for choledochal cyst with chronic calcifying pancreatitis.Heptogastrerology 2004; 51:1504-1505.
  • [7]Lopez RR,Pinson CW,Campbell JR.Variation in management based on type of choledochal cyst.Am J Surg 1991;161:612-15.
  • [8]Chaudhary A,Dhar P,Sachdev A.Reoperative surgery for choledochal cysts.Br J Surg 1997; 84:781-784.
  • [9]Alonso-lej F,Rever WBJr,Pessagno DJ.Congenital choledochal cysts,with a report of 2,and an analysis of 94 cases.Int Abstr Surg 1959;108:1-30.
  • [10]Yamashita H,Otani T,Shioiri T,Takayama T,Kakiuchi C,Todani T,et al.Smallest Todani's type Ⅱ choledochal cyst.Dig Liver Dis 2003; 35:498-502.
  • [11]Iwai N,Yanagihara J,Tokiwa K,Shimotake T,Nakamura K.Congenital choledochal dilatation with emphasis on pathophysiology of the biliary tract.Ann Surg 1992; 215:27-30.
  • [12]Shi LB,Yang DT,Ji ZL.The diagnosis of choledochal cyst by imaging modality J Nanjing Railway Med Coll (Chin) 1997; 16:286-287.
  • [13]Chijiiwa K,Koga A.Surgical management and long-term followup of patients with choledochal cysts.Am J Surg 1993;165:238-242.
  • [14]Tao KS,Lu YG,Wang T.Procedures for congenital choledochal cysts and curative effect analysis in adults.Hepatobiliary Pancreat Dis Int (Chin) 2002; 1:442-445.
  • [15]Benjamin IS.Biliary cystic disease:the risk of cancer.J Hepatobiliary Pancreat Surg 2003; 10:335-339.
  • [16]Yang DT,Shi LB,Wang ZR.Choledochal Cyst:the relation of cystenterostomy and cancer.Chin J Gen Surg (Chin) 1997; 6:1-2.
  • [17]Peng SY,Peng CH,Liu YB.The prevent and treatment of malignancy of choledochal cyst.Chin J Prac Surg (Chin) 1999; 19:674-675.
  • [18]Zhu JY,Peng YF,Leng XS.Diagnosis and treatment of adult congenital choledochocele.Chin J Gen Surg (Chin) 1999; 14:455-456.
  • [19]Madariaga JR,Iwatsuki S,Starzl TE,Todo S,Selby R,Zetti G.Hepatic resection for cystic lesions of the liver.Ann Surg 1993; 218:610-614.
  • [20]Dou KF,Guan WX,Li KZ.Living related liver transplantation:a case report.Chin J Surg (Chin) 1998; 36:203 -205.
  • [21]Sans M,Rimola A,Navasa M,Grande L,Garcia-Valdecasas JC,Andreu H,et al.Liver transplantation in patients with Caroli's disease and recurrent cholangitis.Transpl Int.1997;10:241-244.
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