Surgical treatment for congenital biliary dilatation, with or without intrahepatic bile duct dilatation

The incidence of postoperative cholangitis differs between patients with and those without congenital intrahepatic bile duct dilatation. The aim of this study was to evaluate comparatively the treatment results in these two patients groups.

Forty-eight patients were classified into those with (dilated type) and those without (nondilated type) intrahepatic bile duct dilatation. The surgical procedure used, clinical manifestation, and cell kinetics (proliferating cell nuclear antigen labeling index, PCNALI) of bile duct epithelium were examined with respect to the incidence and course of postoperative cholangitis.

Nineteen patients were classified as the dilated type, and the other 29 patients were the nondilated type. In the dilated-type group, hepaticoduodenostomy was performed on five patients, hepaticojejunostomy (Roux-en-Y method) on eight and jejunal interposition on six. Among the 29 nondilated-type patient, hepaticoduodenostomy was performed on 19 patients, hepaticojejunostomy (Roux-en-Y method) on seven, and jejunal interposition on three. Hepatectomy was performed in one dilated-type adult patient with marked cholangiectasia in the left hepatic lobe. The incidence of postoperative cholangitis was 26.3% (5/19) in the dilated-type group and 6.9% (2/29) in the nondilated-type group. The clinical manifestation was generally mild in the nondilated-type patients. However, among the adult dilated-type patients, on whom jejunal interposition had been performed, there were two patients who required additional surgery for the treatment of cholangitis that occurred postoperatively. The PCNALI in the bile duct epithelium was 13.9% for the dilated-type and 8.8% for the nondilated-type groups, respectively.

Jejunal interposition for biliary reconstruction seems a contraindicated maneuver for adult dilated-type patients, because of the possible development of postoperative cholangitis. The cellular proliferating activity in the bile duct epithelium of the patients of both the dilated and nondilated type was significantly increased compared to that of a control group. Consequently, the extrahepatic bile duct might have to be removed in patients with pancreaticobiliary maljunction regardless of the presence or absence of biliary dilatation.