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Surgical treatment of congenital choledochal cyst
D S Wang1, X H Zheng, D S Chen
1Department of Surgery & Pediatric Surgery, Anhui Provincial Hospital, China.
Insights
This study details a modified Lilly
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Congenital choledochal cysts are rare biliary tract malformations.
- Surgical intervention is the standard treatment for choledochal cysts.
- Effective biliary reconstruction is crucial for long-term outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of a modified Lilly's method for congenital choledochal cyst excision.
- To assess the outcomes of biliary reconstruction techniques following cystectomy.
- To analyze the long-term complications and mortality associated with congenital choledochal cyst treatment.
Main Methods:
- A retrospective review of 20 patients undergoing modified Lilly's method for choledochal cyst from 1980-1985.
- Preoperative diagnostic imaging included ultrasonography, barium meal radiography, and percutaneous transhepatic cholangiography.
- Surgical technique involved choledochal cystectomy with retention of the outer posterior wall layer, modified by saline injection for isolation, followed by biliary reconstruction (choledochoduodenostomy or hepaticojejunostomy) and cholecystectomy in most cases.
Main Results:
- The modified Lilly's method facilitated safe choledochal cyst excision and biliary reconstruction.
- Hepaticojejunostomy was the predominant reconstruction method (18/20 patients).
- Postoperative complications included cirrhosis in 3 patients, with 2 deaths within 8 months, resulting in a 10% mortality rate.
Conclusions:
- The modified Lilly's method offers a safe and effective approach to congenital choledochal cyst management.
- Hepaticojejunostomy appears to be a reliable method for biliary reconstruction in this context.
- Long-term surveillance is essential due to the risk of developing cirrhosis and other complications.
Abstract:
20 cases of congenital choledochal cyst were operated by modified Lilly's method from 1980 to November 1985 in our Hospital. There were 4 males and 16 females. Their ages ranged from 50 days to 15 years with a mean of 5.1 years. All patients had preoperative ultrasonographic examination, barium meal radiography of the gastrointestinal tract or percutaneous transhepatic cholangiography. All had choledochal cystectomy with retention of the outer layer of the posterior wall of the cyst. We modified Lilly's method by injecting normal saline between the outer and inner layer of the choledochal cyst so that the outer layer could be isolated. Reconstruction of the biliary tract was then performed. 2 patients had choledochoduodenostomy and 18 patients had hepaticojejunostomy (1 end to end and 17 end to side). 19 patients had also had cholecystectomy. The post-operative course of the operation was found to be smooth and safe. Patients were followed up for a period from 6 months to 7 years. 3 patients had cirrhosis of liver, 2 of whom died within 8 months. The mortality rate in our series was 10%. The operative treatment and the problems of biliary reconstruction are discussed.