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Choledochal cyst resection and reconstruction by biliary-jejuno-duodenal diversion
Insights
This study on choledochal cysts in 9 pediatric and adult patients demonstrated successful surgical treatment with no mortality. Patients experienced symptom resolution and maintained good liver function post-operation.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Choledochal cysts are congenital bile duct dilatations.
- Symptoms include pain, jaundice, and cholangitis.
- Surgical management aims for cyst excision and reconstruction.
Purpose of the Study:
- To evaluate the surgical technique and outcomes for choledochal cyst treatment.
- To assess the safety and efficacy of a specific biliary-jejunal reconstruction method.
Main Methods:
- Nine patients with choledochal cysts underwent surgery via right subcostal laparotomy.
- A 30-cm isolated jejunal segment was used for biliary-enteric reconstruction.
- Diagnosis utilized intravenous cholangiogram and ultrasound.
Main Results:
- No mortality or serious complications were observed during 1-4 years of follow-up.
- All patients showed symptom resolution, including absence of cholangitis, fever, and pain.
- Postoperative assessments confirmed good liver function and biliary excretion.
Conclusions:
- The described surgical approach for choledochal cysts is safe and effective.
- This technique provides good long-term outcomes and prevents complications like reflux.
Abstract:
From January, 1983 to December, 1986, a total of 9 patients, ranging in age from 2 years and 4 months to 36 years, with choledochal cysts were treated. Symptoms were right upper quadrant pain (n = 9), ascending cholangitis (n = 7), and jaundice (n = 6). A right upper quadrant mass was palpable in 7 patients and gallstones were present in 5 patients. Diagnosis was established by intravenous cholangiogram and ultrasound. The operation was performed through a right subcostal laparotomy. The choledochal cyst diameter ranged from 4.5 to 7 cm. The cyst and the common duct were dissected from the hepatic artery and portal vein. The choledochus was sectioned above the duodenum and the distal end was closed by interrupted sutures. The common duct was divided below the hepatic confluence and the diameter enlarged by longitudinal section of the left hepatic duct. A 30-cm-long segment of isolated jejunum was passed through the transverse mesocolon to the right of the middle colic vessels and behind the duodenum and then interposed between the hepatic confluence and the second portion of the duodenum. Biliary-jejunal anastomosis was performed in 1 layer with interrupted absorbable stitches. No mortality or serious complications occurred during follow-up (1-4 years). No cholangitis, fever, or pain have developed. All patients were studied postoperatively by biochemical test, ultrasonography, Tc 99m DISIDA, and barium meal swallow. Good liver function and biliary excretion, and absence of duodeno-jejuno biliary reflux were demonstrated.