[Development of intrahepatic cholelithiasis long after primary excision of choledochal cysts]

Biliary sricture with dilatation is a putative cause of intrahepatic bile duct stones. However, this hypothesis has never been proven. Fifty-six patients had operative cholangiography, underwent standard excision of a choledochal cyst, and were reviewed at follow-up clinics at a mean follow-up time of 14 years and 6 months. The incidence of complications such as intrahepatic cholelithiasis was analyzed according to the morphologic types of the intrahepatic bile ducts as observed at the initial operation. Group I patients (29 cases) did not show any dilatation of the intrahepatic bile ducts. Only one (3%) developed intrahepatic cholelithiasis. In Group II (24 cases), the intrahepatic bile ducts were dilated but not associated with any down-stream stenosis, one patient (4%) suffered from intrahepatic chalelithasis. Group III patients (3 cases) had dilatation of the intrahepatic bile ducts associated with a down-stream stenosis, and none of them was free from the development of intrahepatic biliary stones (3 cases). Group III patients are most likely to develop intrahepatic cholelithiasis afterwards, and their stenosis should be relieved by whatever means are feasible at initial operation.