Skip to main content

Advertisement

SpringerLink
Log in

Long-term outcomes of surgery for choledochal cysts: a single-institution study focusing on follow-up and late complications

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The late postoperative complications of choledochal cyst (CC) surgery are serious and include intrahepatic stones and biliary carcinoma; therefore, long-term follow-up is crucial.

Methods

The subjects of this retrospective study were patients who underwent surgery for CC at Kagoshima University Hospital between April, 1984 and December, 2016. We analyzed the operative results, early and late postoperative complications, and postoperative follow-up rate.

Results

The study population comprised 110 CC patients (male/female: 33/77) with a median age at surgery of 4 years, 3 months (range 12 days–17 years). The patients underwent hepaticoduodenostomy (n = 1; 0.9%) or hepaticojejunostomy (n = 109; 99.1%). Late complications included intrahepatic bile duct (IHBD) dilatation (n = 1; 0.9%), IHBD stones (n = 3; 2.7%), and adhesive ileus (n = 4; 3.6%). There was no incidence of biliary carcinoma in this series. The rates of follow-up at our institute within 10 years of surgery and more than 20 years after surgery were 69.2% (18 of 26) and 14.5% (8 of 55), respectively.

Conclusions

The follow-up rate after definitive surgery declined with time. Late complications were observed within 20 years, but biliary carcinoma was not observed. The follow-up rate should be increased to detect late complications. Moreover, patient education on long-term follow up is essential to prevent life-threatening events after definitive surgery for CC.

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

Fig. 1

Similar content being viewed by others

References

  1. Babbitt DP. Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb. Ann Radiol (Paris). 1969;12:231–40.

    CAS  Google Scholar 

  2. Singham J, Yoshida EM, Scudamore CH. Choledochal cysts: part 2 of 3: diagnosis. Can J Surg. 2009;52:506–11.

    PubMed  PubMed Central  Google Scholar 

  3. Edil BH, Cameron JL, Reddy S, Lum Y, Lipsett PA, Nathan H, et al. Choledochal cyst disease in children and adults: a 30-year single-institution experience. J Am Coll Surg. (2008);206:1000–5, (discussion 5–8).

  4. Nagi B, Kochhar R, Bhasin D, Singh K. Endoscopic retrograde cholangiopancreatography in the evaluation of anomalous junction of the pancreaticobiliary duct and related disorders. Abdom Imaging. 2003;28:847 – 52.

    Article  PubMed  CAS  Google Scholar 

  5. Ishibashi H, Shimada M, Kamisawa T, Fujii H, Hamada Y, Kubota M, et al. Japanese clinical practice guidelines for congenital biliary dilatation. J Hepat Pancreat Sci. 2017;24:1–16.

    Article  Google Scholar 

  6. 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;44:2307–11.

    Article  PubMed  Google Scholar 

  7. Todani T, Watanabe Y, Toki A, Morotomi Y. Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. J Hepat Pancreat Surg. 2003;10:340–4.

    Article  Google Scholar 

  8. Takeshita N, Ota T, Yamamoto M. Forty-year experience with flow-diversion surgery for patients with congenital choledochal cysts with pancreaticobiliary maljunction at a single institution. Ann Surg. 2011;254:1050–3.

    Article  PubMed  Google Scholar 

  9. Todani T, Watanabe Y, Urushihara N, Noda T, Morotomi Y. Biliary complications after excisional procedure for choledochal cyst. J Pediatr Surg. 1995;30:478 – 81.

    Article  PubMed  CAS  Google Scholar 

  10. Chijiiwa K, Tanaka M. Late complications after excisional operation in patients with choledochal cyst. J Am Coll Surg. 1994;179:139 – 44.

    PubMed  CAS  Google Scholar 

  11. Saing H, Han H, Chan KL, Lam W, Chan FL, Cheng W, et al. Early and late results of excision of choledochal cysts. J Pediatr Surg. 1997;32:1563–6.

    Article  PubMed  CAS  Google Scholar 

  12. Tsuchida Y, Takahashi A, Suzuki N, Kuroiwa M, Murai H, Toki F, et al. Development of intrahepatic biliary stones after excision of choledochal cysts. J Pediatr Surg. 2002;37:165–7.

    Article  PubMed  Google Scholar 

  13. Ono S, Maeda K, Baba K, Usui Y, Tsuji Y, Yano T, et al. The efficacy of double-balloon enteroscopy for intrahepatic bile duct stones after Roux-en-Y hepaticojejunostomy for choledochal cysts. Pediatr Surg Int. 2013;29:1103–7.

    Article  PubMed  Google Scholar 

  14. Watanabe Y, Toki A, Todani T. Bile duct cancer developed after cyst excision for choledochal cyst. J Hepat Pancreat Surg. 1999;6:207 – 12.

    Article  CAS  Google Scholar 

  15. Kobayashi S, Asano T, Yamasaki M, Kenmochi T, Nakagohri T, Ochiai T. Risk of bile duct carcinogenesis after excision of extrahepatic bile ducts in pancreaticobiliary maljunction. Surgery. 1999;126:939 – 44.

    Article  PubMed  CAS  Google Scholar 

  16. Wang D, Liu Z, Li Z, Li D, Chen J, Zheng S, et al. Surgical treatment of congenital biliary duct cyst. BMC Gastroenterol. 2012;12:29.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Zheng X, Gu W, Xia H, Huang X, Liang B, Yang T, et al. Surgical treatment of type IV-A choledochal cyst in a single institution: children vs. adults. J Pediatr Surg. 2013;48:2061–6.

    Article  PubMed  Google Scholar 

  18. Ono S, Sakai K, Kimura O, Iwai N. Development of bile duct cancer in a 26-year-old man after resection of infantile choledochal cyst. J Pediatr Surg. 2008;43:E17-9.

    Article  PubMed  Google Scholar 

  19. Shimamura K, Kurosaki I, Sato D, Takano K, Yokoyama N, Sato Y, et al. Intrahepatic cholangiocarcinoma arising 34 years after excision of a type IV-A congenital choledochal cyst: report of a case. Surg Today. 2009;39:247 – 51.

    Article  PubMed  Google Scholar 

  20. Ohashi T, Wakai T, Kubota M, Matsuda Y, Arai Y, Ohyama T, et al. Risk of subsequent biliary malignancy in patients undergoing cyst excision for congenital choledochal cysts. J Gastroenterol Hepatol. 2013;28:243–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ng DW, Chiow AK, Poh WT, Tan SS. Metachronous cholangiocarcinoma 13 years post resection of choledochal cyst-is long-term follow-up useful?: a case study and review of the literature. Surg Case Rep. 2016;2:60.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS, Nos. 16K10466, 16K10094, 16K10095, 16K10434, 16H07090, 17K10555, 17K11514, 17K10183, 17K11515), a Research Grant from President’s Discretionary Expenses of Kagoshima University, a Research Grant from The UBE Foundation, a Research Grant from Kawano Masanori Memorial Public Interest Incorporated Foundation for Promotion of Pediatrics, a Research Grant from Tateishi Science and Technology Foundation, a Research Grant from Mitsui Life Social Welfare Foundation, and a Research Grant from The Kurata Grants of the Hitachi Global Foundation.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Motoi Mukai, Tatsuru Kaji, Ryuta Masuya, Koji Yamada, Koshiro Sugita, Tomoe Moriguchi, Shun Onishi, Waka Yamada, Takafumi Kawano, Seiro Machigashira, Kazuhiko Nakame, Hideo Takamatsu & Satoshi Ieiri

Authors
  1. Motoi Mukai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tatsuru Kaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryuta Masuya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koji Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Koshiro Sugita
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tomoe Moriguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shun Onishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Waka Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takafumi Kawano
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Seiro Machigashira
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kazuhiko Nakame
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hideo Takamatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Satoshi Ieiri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Satoshi Ieiri.

Ethics declarations

Conflict of interest

We have no conflicts of interest to declare in association with the present study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mukai, M., Kaji, T., Masuya, R. et al. Long-term outcomes of surgery for choledochal cysts: a single-institution study focusing on follow-up and late complications. Surg Today 48, 835–840 (2018). https://doi.org/10.1007/s00595-018-1660-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-018-1660-9

Keywords

Search

Navigation