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Reoperative surgery for choledochal cysts
A Chaudhary1, P Dhar, A Sachdev
1Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital, New Delhi, India.
The British Journal of Surgery
|June 1, 1997
Summary
Choledochal cyst excision is feasible after prior drainage. External drainage may be best for critically ill patients with complications, offering a safer initial approach before definitive surgery.
Area of Science:
- Hepatobiliary Surgery
- Surgical Gastroenterology
Background:
- Choledochal cysts frequently develop complications when treated with simple internal or external drainage.
- This study focuses on reoperations for choledochal cysts previously managed by drainage.
Purpose of the Study:
- To evaluate the feasibility and outcomes of choledochal cyst excision in patients with prior drainage procedures.
- To determine optimal initial management strategies for complicated choledochal cysts.
Main Methods:
- Retrospective review of 17 patients (10 female, 7 male) over 9 years.
- Patients had undergone previous cystoenterostomy (n=9) or external drainage (n=8).
- Indications for reoperation included stones, pancreatitis, portal hypertension, and hepatic abscess.
Main Results:
- Cyst excision was successful in all patients with prior external drainage and 7/9 with prior cystoenterostomy.
- No mortality was observed.
- Postoperative complications included two biliary leaks and two duodenal fistulas, all resolving spontaneously.
Conclusions:
- Choledochal cyst excision is achievable and recommended, even after initial drainage.
- External drainage can be a preferred initial step for severely ill patients with choledochal cyst complications.