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Treatment of choledochal cyst by excision
Insights
Excision of choledochal cysts with Roux-en-Y hepaticojejunostomy offers a safe and effective treatment, significantly reducing complications like cholangitis and preventing bile duct cancer.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Choledochal cysts are congenital dilations of the bile ducts.
- Traditional treatments often involve internal drainage, which can lead to complications.
- Recurrence of biliary obstruction and cholangitis necessitates further surgical intervention.
Purpose of the Study:
- To evaluate the safety and efficacy of choledochal cyst excision with Roux-en-Y hepaticojejunostomy.
- To assess long-term outcomes, including complications and recurrence rates.
- To support cyst excision as a preferred treatment over internal drainage procedures.
Main Methods:
- Seven pediatric patients underwent cyst excision and Roux-en-Y hepaticojejunostomy.
- Cysts were located distal to the confluence of hepatic ducts.
- Partial excision of distal cyst and proximal remnant preservation were employed to protect adjacent organs and facilitate anastomosis.
Main Results:
- No serious intraoperative complications were observed.
- Prolonged drainage from drain sites occurred in two patients (2-3 weeks).
- All patients maintained normal liver function tests, with no episodes of cholangitis or jaundice during a median follow-up of 4.5 years.
Conclusions:
- Cyst excision with Roux-en-Y hepaticojejunostomy is associated with low mortality and morbidity.
- This procedure eliminates bile stasis and pancreatic reflux, potentially preventing bile duct carcinoma.
- Excision is preferred over internal drainage for definitive management of choledochal cysts.
Abstract:
Since 1969 excision of choledochal cyst and establishment of bile drainage by Roux-en-Y hepaticojejunostomy has been performed in 7 children whose ages ranged from 10 mo to 11 yr. In 3 children, the cyst had been treated 5 yr, 4 wk, and 3 wk previously by cystduodenostomy, cystjejunostomy, and cholecystduodenostomy, respectively; further surgery was indicated for biliary obstruction and severe cholangitis. The other four children were not acutely ill. All cysts were located distal to the confluence of the right and left hepatic ducts. The volume of the smallest cyst was 25 ml and the largest 500 ml. In all children a small remnant of distal cyst was not excised to avoid injury to the duodenum and pancreas. In four children a remnant of proximal cyst was left attached to the hepatic duct to allow a large biliary intestinal anastomosis and minimize the possibility of stricture. No serious intraoperative problems were encountered. Prolonged drainage (2-3 wk) from Penrose drain sites in two children were the only postoperative complications. Liver function tests have remained normal in all and no episodes of cholangitis or jaundice have been noted during follow-up (median: 4.5 yr). This experience supports recent reports that indicate that cyst excision is associated with low mortality and morbidity. Cyst excision is preferred over traditional internal drainage procedures because it (A) eliminates a reservoir for bile stasis, (B) removes a mechanism which allows continuous reflux of pancreatic juice into the cyst, and (C) probably prevents the occurrence of bile duct carcinoma which has been noted in 3.0% of patients with choledochal cyst.