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Long-term complications after extrahepatic cyst excision for type IV-A choledochal cysts
Utpal Anand1, Aaron George John1, Rajeev Nayan Priyadarshi2
1Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India.
Annals of Hepato-Biliary-Pancreatic Surgery
|May 2, 2023
Summary
Extrahepatic cyst excision for type IV-A choledochal cysts (CDC) frequently leads to long-term complications. Patients require ongoing monitoring for issues like cholangitis and intrahepatic stones.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Choledochal cysts (CDC) are congenital biliary malformations.
- Type IV-A CDC involves multiple cystic dilatations of both intrahepatic and extrahepatic bile ducts.
- Extrahepatic cyst excision is a standard surgical approach.
Observation:
- This study followed 45 adults with type IV-A CDC post-extrahepatic cyst excision.
- Median follow-up was 25 months (range, 2-10 years).
- The focus was on long-term complications in the remaining intrahepatic bile duct system.
Findings:
- Late complications occurred in 10 patients (22.2%).
- Common complications included cholangitis/intrahepatic stones (9 patients), anastomotic stricture (6 patients), and left lobar atrophy (3 patients).
- Six patients needed re-do hepaticojejunostomy (HJ), with three experiencing recurrent cholangitis despite patent anastomoses.
Implications:
- Extrahepatic cyst excision for type IV-A CDC is associated with frequent and significant long-term complications.
- A prolonged and vigilant follow-up strategy is essential for managing these patients.
- Further research may explore strategies to mitigate these late sequelae.
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