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Early and late results of excision of choledochal cysts
Insights
Long-term follow-up is crucial after choledochal cyst excision with hepaticojejunostomy in children. While most children experience a good quality of life, some develop complications years later.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Late results of choledochal cyst excision with hepaticojejunostomy in pediatric patients are infrequently reported.
- Choledochal cysts are congenital dilations of the bile ducts requiring surgical intervention.
Purpose of the Study:
- To evaluate the long-term outcomes of choledochal cyst excision with hepaticojejunostomy in children.
- To identify potential late complications and the necessity for ongoing patient monitoring.
Main Methods:
- Retrospective analysis of 41 pediatric patients undergoing cyst excision and hepaticojejunostomy since 1972.
- Utilized a 40-cm Roux loop without an antireflux procedure.
- Follow-up ranged from 4 months to 17 years.
Main Results:
- No mortality was observed in the cohort.
- Two patients developed anastomotic stricture, cholangitis, and intrahepatic stones after 8 and 11 years, requiring further surgery.
- One patient developed asymptomatic intrahepatic stones 2 years post-operatively.
Conclusions:
- Choledochal cyst excision with hepaticojejunostomy can lead to a good quality of life for pediatric patients.
- Vigilant, long-term follow-up is essential to detect and manage late-developing complications after this procedure.
Background/Purpose:
Reports on the late results of choledochal cyst excision with hepaticojejunostomy in children are relatively few.
Methods:
Of the 84 patients who had choledochal cyst who came under our care, 79 have had definitive surgery, three are awaiting surgery, one is being observed with Caroli's disease, and the parents of one child have refused surgery. Thirty-eight patients treated decades ago had internal drainage procedures. Since 1972, 41 patients have had cyst excision with hepaticojejunostomy using a 40-cm Roux loop without an antireflux procedure. Early complications in those who underwent cyst excision with hepaticojejunostomy included anastomotic leak in three patients who required reoperation, cholangitis in two, and fluid collection in the gall-bladder bed that required no intervention in one.
Results:
During a follow-up period ranging from 4 months to 17 years (mean, 8.5 years), anastomotic stricture, cholangitis, and intrahepatic stone formation developed in two children after being well for 8 years and over 11 years. These children required additional surgical procedures to overcome their problems. Asymptomatic intrahepatic stones 2 years after cyst excision with hepaticojejunostomy developed in a third child. There was no mortality in the entire group that underwent cyst excision and they are all enjoying a good quality of life.
Conclusions:
Careful, long-term follow-up is important in children who have choledochal cyst excision with hepaticojejunostomy.