Bile duct cysts: A changing spectrum of presentation
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Since the report of our early experience in 1984, the clinical management of 33 patients (23 adults, 10 children) with bile duct cysts has been reviewed. The mean age was 28 years, and female preponderance was observed. Complicated clinical presentations (namely, cholangitis) and coexistent hepato-biliary-pancreatic diseases (present in 45% of the patients) were encountered more frequently in adult patients and those who had had previous cyst enteric drainage operations. Pancreatitis occurred in 27% and cyst-associated malignancy in 9%, with 2 patients alive 29 and 125 months, respectively, postoperatively after curative resection. Cyst type included type I, 58%; type II, 3%; and type VIA, 33%. Anomalous biliary-pancreatic junction (as a long common channel in 18 patients) was observed in 19 patients in whom the anatomy was documented. Eighteen patients (group I) underwent primary extrahepatic cyst excision, and 15 patients (group II) with previous cyst-related operations (35 previous surgical procedures) underwent secondary cyst excision. Mortality was nil, but postoperative morbidity was significantly higher in group II. During a mean follow-up of 51 months, satisfactory results were observed in 94% of the patients. In conclusion, primary complete cyst excision of extrahepatic component is recommended as the treatment of choice, achieving satisfactory clinical results in the majority of patients. The clinical spectrum of the disease has changed in our experience because of the routine use of early cyst excision in patients with bile duct cysts.
Key wordscholedochal cyst surgery resection
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