[Current therapy of bile duct cysts. I. Extrahepatic cysts]

A total of 23 patients with extrahepatic biliary cysts (11 type I, 4 type II, 4 type III and 4 type IVa according to the classification by Todani) seen at our institution in a 15-year period were reviewed with emphasis on management and long-term results at follow-up of 3 weeks-12 years. Associated hepatobiliary disease occurred in 4 patients, including one case with malignant degeneration in the cyst 23 years after cystenterostomy, and an association of a gallbladder carcinoma with a choledochocele in the other patient. Radical excision of the dilated bile duct and reconstruction by Roux-en-Y hepatico-jejunostomy was performed in 13 cases (9 type I, 3 type II and 1 type III), combined in 3 cases with an antireflux valve. All 13 operated on patients remained in good health for 6 months to 12 years. These results confirm the need for complete early excision of type I, (II) and IVa cysts at all ages before severe complications can occur. Endoscopic treatment of type III choledochocele should be limited to the management of smaller lesions.