Choledochal cysts: results of primary surgery and need for reoperation in young patients

The UCLA Medical Center experience in the surgical treatment of 23 young patients with choledochal cysts over a 28 year period has been reviewed. All patients had saccular or fusiform extrahepatic cysts, and one patient also had a diverticular cyst. Eleven patients had no intrahepatic dilatation, whereas 9 had cylindrical and 3 cystic intrahepatic dilatation. There were 39 operations for biliary drainage performed: 17 Roux-Y choledochojejunostomies, 7 choledochoduodenostomies, 7 excisions, and 8 miscellaneous procedures. The morbidity for initial operations was 17 percent and for reoperations, 31 percent. Biliary calculi were found after 2 of 23 primary operations (9 percent) and 6 of 16 reoperations (37.5 percent). All developed while enteric drainage was present and were primary bile duct stones. No reoperation was necessary after cyst excision. An intrahepatic cholangiocarcinoma developed in one patient treated with enteric drainage. Three of 10 patients who did not undergo cholecystectomy at their initial operation later required laparotomy for cholecystectomy alone. We recommend cholecystectomy and cyst excision when technically feasible for primary operative treatment of choledochal cysts.