Surgical outcome of choledochal cysts in adults: a prospective cohort study

Background Choledochal cysts (CCs) are cystic dilatation of the biliary ductal system. Adult cases comprise around 20% of all cases. Purpose The aim of this study was to integrate all possible technical methods to prevent complications arising from residual choledochal tissue by presenting our experience in adult patients. Patients and methods A prospective cohort study of 24 adult patients, who underwent surgery for CC, over a 4-year period from March 2013 to February 2017 at the Gastroenterology Surgical Unit, Faculty of Medicine, Alexandria University, Egypt, was carried out. Cysts were classified according to the Todani classification. Biliary anatomy was defined by intraoperative cholangiography. Results The present study included six males and 18 females. Their ages ranged from 18 to 43 years (mean 26.4 years). Pain was the most common symptom at presentation (20 patients, 83.3%). Eighteen patients (75%) had type I cysts. All patients underwent excision of the extrahepatic bile duct cyst. The mean follow-up period was 34.6 months. Conclusion The present study showed satisfactory medium-term results following surgical resection of adult CC. Our approach was effective, to a great extent, in preventing complications of residual cysts. Excision of the extrahepatic bile duct should be guided by intraoperative cholangiography and distal clips to avoid pancreatic duct injury.

[1]  J. Molacek,et al.  [Choledochal cyst]. , 2020, Rozhledy v Chirurgii.

[2]  M. Jiménez-López,et al.  Biliary cysts in adults. 26 years experience at a single center , 2016, Annals of medicine and surgery.

[3]  A. Ejaz,et al.  Management of choledochal cysts , 2016, Current opinion in gastroenterology.

[4]  N. Machado,et al.  Choledochal Cyst in Adults: Etiopathogenesis, Presentation, Management, and Outcome—Case Series and Review , 2015, Gastroenterology research and practice.

[5]  G. Spolverato,et al.  Presentation and Clinical Outcomes of Choledochal Cysts in Children and Adults: A Multi-institutional Analysis. , 2015, JAMA surgery.

[6]  C. Yeung,et al.  Common Bile Duct Dilatations in Asymptomatic Neonates: Incidence and Prognosis , 2014, Gastroenterology research and practice.

[7]  Jiahong Dong,et al.  Surgical treatment of type IV-A choledochal cyst in a single institution: children vs. adults. , 2013, Journal of pediatric surgery.

[8]  M. Yamoto,et al.  Long-term outcomes after excision of choledochal cysts in a single institution: operative procedures and late complications. , 2012, Journal of pediatric surgery.

[9]  Sang Wook Park,et al.  One Case of Common Bile Duct Cancer Mimicking Cystic Neoplasm of the Pancreas, Arising 9 Years after Excision of a Choledochal Cyst , 2012, Clinical endoscopy.

[10]  H. Dutta Hepatic lobectomy and mucosectomy of intrahepatic cyst for type IV-A choledochal cyst. , 2012, Journal of pediatric surgery.

[11]  T. Koshinaga,et al.  Persistent biliary dilatation and stenosis in postoperative congenital choledochal cyst , 2011, Journal of hepato-biliary-pancreatic sciences.

[12]  Der-Fang Chen,et al.  Choledochal Cysts: Differences Between Pediatric and Adult Patients , 2010, Journal of Gastrointestinal Surgery.

[13]  S. Ono,et al.  Long-term outcomes after hepaticojejunostomy for choledochal cyst: a 10- to 27-year follow-up. , 2010, Journal of pediatric surgery.

[14]  P. Tam,et al.  Management of choledochal cyst: 30 years of experience and results in a single center. , 2009, Journal of pediatric surgery.

[15]  D. Geller,et al.  The Changing Presentation of Choledochal Cyst Disease: An Incidental Diagnosis , 2009, HPB surgery : a world journal of hepatic, pancreatic and biliary surgery.

[16]  E. Auyang,et al.  Laparoscopic Management of a Cystic Duct Cyst , 2009, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[17]  Po-Huang Lee,et al.  Clinicopathological Feature and Surgical Outcome of Choledochal Cyst in Different Age Groups: The Implication of Surgical Timing , 2008, Journal of Gastrointestinal Surgery.

[18]  B. Yoo,et al.  Risk Factors of Postoperative Anastomotic Stricture After Excision of Choledochal Cysts with Hepaticojejunostomy , 2008, Journal of Gastrointestinal Surgery.

[19]  C. Scudamore,et al.  Choledochal cysts: analysis of disease pattern and optimal treatment in adult and paediatric patients. , 2007, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[20]  C. Scudamore,et al.  Epidemiology, presentation, diagnosis, and outcomes of choledochal cysts in adults in an urban environment. , 2005, American journal of surgery.

[21]  D. Gouma,et al.  Choledochal cysts: age of presentation, symptoms, and late complications related to Todani's classification. , 2002, Journal of pediatric surgery.

[22]  Minju Li,et al.  Early complications after excision with hepaticoenterostomy for infants and children with choledochal cysts. , 2002, Hepatobiliary & Pancreatic Diseases International.

[23]  S. Fan,et al.  Choledochal cysts in adults. , 2002, Archives of surgery.

[24]  H. Nagai,et al.  Pancreatic Complications in Choledochal Cyst and Their Surgical Outcomes , 2001, World Journal of Surgery.

[25]  C. Peng,et al.  Diagnosis and treatment of congenital choledochal cyst: 20 years' experience in China. , 2001, World journal of gastroenterology.

[26]  T. Ochiai,et al.  Risk of bile duct carcinogenesis after excision of extrahepatic bile ducts in pancreaticobiliary maljunction. , 1999, Surgery.

[27]  T. Todani Congenital choledochal dilatation: Classification, clinical features, and long-term results , 1997 .

[28]  H. Takehara,et al.  Does the type of anomalous arrangement of pancreaticobiliary ducts influence the surgery and prognosis of choledochal cyst? , 1992, Journal of pediatric surgery.

[29]  O. C. L. Fonseca-Neto,et al.  Surgical management of cystic dilatation bile ducts in adults , 2015 .

[30]  P. Lai,et al.  Adult choledochal cyst. , 2005, Asian journal of surgery.

[31]  Y. Jan,et al.  Malignancy in choledochal cysts. , 2000, Hepato-gastroenterology.