Skip to main content
SpringerLink
Log in

Selection of the Surgical Approach for Reoperation of Adult Choledochal Cysts

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background/Purpose

Our purpose was to evaluate the reasons for reoperations and outcomes in patients with choledochal cysts (CCs).

Methods

The records of patients with CCs who underwent reoperations from 1995 to 2012 were retrospectively reviewed.

Results

Of 165 patients with a mean age of 42.54 ± 14.05 years, 62 had Todani type I (37.6 %), 84 type IV-A (50.9 %), and 19 had unknown type CCs (11.5 %). Previous surgery was internal or external drainage alone in 66.1 % of patients with type I and 23.8 % of patients with type IV-A CCs. Partial cyst excision and Roux-en-Y cyst-jejunostomy or cyst excision and choledochoplasty by jejunal interposition were performed in 16.1 and 11.3 % of patients with type I and IV-A CCs, respectively. Reoperations at our hospital were maximal cyst excision and Roux-en-Y hepaticojejunostomy. Radical cyst excision was achieved in 93.5 % of patients with type I and 44.0 % of patients with type IV-A CCs. With an average follow-up of 48.23 ± 12.30 months, recurrent cholangitis and biliary-enteric anastomotic stenosis occurred in 18 (13.2 %) and 9 patients (6.6 %), respectively. Long-term biliary function was excellent or good in 83.8 % of patients.

Conclusions

Radical cyst excision and Roux-en-Y hepaticojejunostomy provide good outcomes in patients with CCs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chen HM, Jan YY, Chen MF, Wang CS, Jeng LB, Hwang TL, et al. Surgical treatment of choledochal cyst in adults: results and long-term follow-up. Hepatogastroenterology 1996; 43:1492-1499.

    CAS  PubMed  Google Scholar 

  2. Lenriot JP, Gigot JF, Segol P, Fagniez PL, Fingerhut A, Adloff M. Bile duct cysts in adults: a multi-institutional retrospective study. French Associations for Surgical Research. Ann Surg 1998; 228:159-166.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Atkinson HD, Fischer CP, de Jong CH, Madhavan KK, Parks RW, Garden OJ. Choledochal cysts in adults and their complications. HPB (Oxford) 2003; 5:105-110.

    Article  CAS  Google Scholar 

  4. Howell CG, Templeton JM, Weiner S, Glassman M, Betts JM, Witzleben CL. Antenatal diagnosis and early surgery for choledochal cyst. J Pediatr Surg 1983; 18:387-393.

    Article  CAS  PubMed  Google Scholar 

  5. Kasai M, Asakura Y, Taira Y. Surgical treatment of choledochal cyst. Ann Surg 1970; 172:844-851.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 1977; 134:263-269.

    Article  CAS  PubMed  Google Scholar 

  7. She WH, Chung HY, Lan LC, Wong KK, Saing H, Tam PK. Management of choledochal cyst: 30 years of experience and results in a single center. J Pediatr Surg 2009; 44:2307-2311.

    Article  PubMed  Google Scholar 

  8. Komi N, Tamura T, Miyoshi Y, Kunitomo K, Udaka H, Takehara H. Nationwide survey of cases of choledochal cyst. Analysis of coexistent anomalies, complications and surgical treatment in 645 cases. Surg Gastroenterol 1984; 3:69-73.

    CAS  PubMed  Google Scholar 

  9. Caudle SO, Dimler M. The current management of choledochal cyst. Am Surg 1986; 52:76-80.

    CAS  PubMed  Google Scholar 

  10. Voyles CR, Smadja C, Shands WC, Blumgart LH. Carcinoma in choledochal cysts. Age-related incidence. Arch Surg 1983; 118:986-988.

    Article  CAS  PubMed  Google Scholar 

  11. Todani T, Watanabe Y, Toki A, Urushihara N. Carcinoma related to choledochal cysts with internal drainage operations. Surg Gynecol Obstet 1987; 164:61-64.

    CAS  PubMed  Google Scholar 

  12. Jan YY, Chen HM, Chen MF. Malignancy in choledochal cysts. Hepatogastroenterology 2000; 47:337-340.

    CAS  PubMed  Google Scholar 

  13. Bismuth H, Krissat J. Choledochal cystic malignancies. Ann Oncol 1999; 10 (Suppl 4):94-98.

    Article  PubMed  Google Scholar 

  14. Cho MJ, Hwang S, Lee YJ, Kim KH, Ahn CS, Moon DB, et al. Surgical experience of 204 cases of adult choledochal cyst disease over 14 years. World J Surg 2011; 35:1094-1102.

    Article  PubMed  Google Scholar 

  15. Kim JH, Choi TY, Han JH, Yoo BM, Kim JH, Hong J, et al. Risk factors of postoperatire anastomotic stricture after excision of choledochal cysts with hepaticojejunostomy. J Gastrointest Surg 2008; 12:822-828.

    Article  PubMed  Google Scholar 

  16. You Y, Gong JP. Diagnosis and management experience of adult choledochal cysts: reasons for reoperation. Hepatogastroenterology 2013; 60:470-474.

    PubMed  Google Scholar 

  17. Harring TR, Nguyen NT, Liu H, Goss JA, O'Mahony CA. Caroli disease patients have excellent survival after liver transplant. J Surg Res 2012; 177:365-372.

    Article  PubMed  Google Scholar 

  18. Moraca RJ, Lee FT, Ryan JA Jr, Traverso LW. Long-term biliary function after reconstruction of major bile duct injuries with hepaticoduodenostomy or hepaticojejunostomy. Arch Surg 2002; 137:889-893.

    Article  PubMed  Google Scholar 

  19. Lillemoe KD, Melton GB, Cameron JL, Pitt HA, Campbell KA, Talamini MA, et al. Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg 2000; 232:430-441.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Lipsett PA, Pitt HA, Colombani PM, Boitnott JK, Cameron JL. Choledochal cyst disease. A changing pattern of presentation. Ann Surg 1994; 220:644-652.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Chijiiwa K, Tanaka M. Late complications after excisional operation in patients with choledochal cyst. J Am Coll Surg 1994; 179:139-144.

    CAS  PubMed  Google Scholar 

  22. Schier F, Clausen M, Kouki M, Gdanietz K, Waldschmidt J. Late results in the management of choledochal cysts. Eur J Pediatr Surg 1994; 4:141-144.

    Article  CAS  PubMed  Google Scholar 

  23. Congo K, Lopes MF, Oliveira PH, Matos H, Basso S, Reis A. Outcomes of choledochal cysts with or without intrahepatic involvement in children after extrahepatic cyst excision and Roux-en-Y hepaticojejunostomy. Ann Hepatol 2012; 11:536-543.

    PubMed  Google Scholar 

  24. Tao KS, Lu YG, Wang T, Dou KF. Procedures for congenital choledochal cysts and curative effect analysis in adults. Hepatobiliary Pancreat Dis Int 2002; 1:442-445.

    PubMed  Google Scholar 

  25. Urushihara N, Fukumoto K, Fukuzawa H, Mitsunaga M, Watanabe K, Aoba T, et al. Long-term outcomes after excision of choledochal cysts in a single institution: operative procedures and late complications. J Pediatr Surg 2012; 47:2169-2174.

    Article  PubMed  Google Scholar 

  26. Ziegler KM, Pitt HA, Zyromski NJ, Chauhan A, Sherman S, Moffatt D, et al. Choledochoceles: are they choledochal cysts? Ann Surg 2010; 252:683-690.

    PubMed  Google Scholar 

Download references

Acknowledgments

None.

Author information

Authors and Affiliations

  1. Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 100853, Beijing, China

    Hong-Tian Xia, Jia-Hong Dong, Tao Yang, Bin Liang & Jian-Ping Zeng

Authors
  1. Hong-Tian Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jia-Hong Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bin Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jian-Ping Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hong-Tian Xia.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xia, HT., Dong, JH., Yang, T. et al. Selection of the Surgical Approach for Reoperation of Adult Choledochal Cysts. J Gastrointest Surg 19, 290–297 (2015). https://doi.org/10.1007/s11605-014-2684-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-014-2684-0

Keywords

Search

Navigation