Cystic dilatation of the common bile duct: surgical treatment and long-term results

Twelve patients (11 female) with an extrahepatic biliary cyst (six type I, three type II and three type III according to the classification of Todani) are reviewed with emphasis on aetiology, clinical features and long-term results at follow-up of 3-10 years. The clinical manifestations were abdominal pain, cholestasis with jaundice, fever and episodes of pancreatitis. The diagnosis was established before surgery in all cases by ultrasonography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and computed tomography. An abnormally long common channel was found in four patients. Three patients had had cysts drained internally in the 1970s. Of these three patients, one developed carcinoma of the cyst 23 years later. Radical excision of the dilated bile duct and reconstruction by Roux-en-Y hepaticojejunostomy was performed in nine cases. Two patients, each with a small choledochocele, were treated successfully by endoscopic sphincterotomy and stone extraction. There were no serious postoperative complications. All nine patients operated on remained in good health for 3-10 years. These results support radical excision of the cystically dilated bile duct with reconstruction by end-to-side Roux-en-Y hepaticojejunostomy for types I and II cyst. Endoscopic treatment of type III choledochocele should be limited to the management of smaller lesions.