Reoperation for Congenital Choledochal Cyst
Takuji Todani, Yasuhiro Watanabe, Akira Toki, Naoto Urushihara,
Yasuhisa Sato
Ann Surg 207: 142-147, 1988
A reoperation after excisional procedure was carried out
in seven cases due to early or late postoperative complications. Of the
12 patients with early complications, four underwent relaparotomy due to
anastomotic leakage and bleeding. Late complications were seen in nine patients
with recurrent cholangitis caused by an anastomotic stricture, and three
patients with intrahepatic involvement required a reoperation several years
after the initial surgery. Recurrent cholangitis after biliary reconstruction
mainly occurs due to an anastomotic stricture of the hepaticoenterostomy.
There was no significant difference in the results between hepaticoduodenostomy
and hepaticojejunostomy over a long follow-up period. A wide anastomotic
stoma that permits free drainage of bile into the intestine is imperative
to the prevention of cholangitis, and can be created by an incision extending
along the lateral wall of both the hepatic ducts with a hepaticoenterostomy
at the hilum. This procedure is obviously necessary in all patients with
or without intrahepatic involvement. Carcinoma of the intrahepatic ducts
and the retained distal choledochus have rarely developed in patients undergoing
cyst excision followed by biliary reconstruction. Complete excision of the
whole extrahepatic bile duct could prevent carcinoma arising in the distal
choledochus, although it could not prevent carcinoma arising from the intrahepatic
ducts. However, patients with carcinoma of the intrahepatic duct were reported
to have had symptoms of biliary stricture for a long time since the cyst
excision. Bile stagnation in the intrahepatic ducts is possibly responsible
for the development of carcinoma. A wide anastomosis resulting in free drainage
of bile appears to be essential to the prevention of carcinoma arising in
the intrahepatic ducts after cyst excision.
Return