Hazard and outcome of retreated choledochal cyst patients

Thirty-nine patients initially treated for choledochal cyst (25: cyst-enterostomy for 15 type I and 10 type IV A, 13: cyst excision for 8 type I and 5 type IV A, 1: sphincterotomy for type III) have been completely followed up for a mean period of 17 years to examine the effect of surgical management on their lives. Eighteen of 25 cases with cyst-enterostomy (72%) needed retreatment due to the complications but one could not be retreated because of the presence of advanced bile duct carcinoma. Fourteen of 17 cases were retreated with cyst excision, of whom 12 showed an excellent outcome but other two were suffering from cholangitis and hepatolithiasis. The remaining 3 patients retreated with PTCS or cyst-enterostomy showed a poor outcome. Of 13 patients who had undergone cyst excision with hepatico-jejunostomy as the first choice, 12 showed a good outcome but one needed retreatment due to the anastomotic stenosis and hepatolithiasis. Thus, excision of cyst should be the surgical management for choledochal cyst. However, it should be noted that three of 27 patients treated initially or secondarily with cyst excision showed unsatisfactory results mainly due to the anastomotic stenosis. The results demonstrate that hepaticojejunostomy with a wide opening stoma is necessary to prevent postoperative morbidity.