Surgical techniques and long-term results in the treatment of choledochal cyst

A personal follow-up of 52 cases of choledochal cyst managed over a 28-year period has provided a unique opportunity to review the long-term problems and outcome. Eleven patients had internal drainage procedures and at least four have developed cholangitis more than 10 years later, with three requiring reoperation and cyst excision. Of the 41 patients who had cyst excision, 34 were performed personally by the author; 33 have remained completely well, whereas one died subsequently of cholangiocarcinoma. Complete cyst excision can be successfully achieved provided the dissection of the distal part of the cyst is carried out in a clear, bloodless field obtained by working directly on the cyst wall beneath the overlying loose areolar tissue. Partial excision, mucosectomy, and operative cholangiograms have not been found necessary. This study provides conclusive evidence that any anastomosis of cyst wall to the gastrointestinal tract will ultimately result in stricture and cholangitis.