Surgical treatment of choledochal cysts in children
Takuji Todani, Yasuhiro Watanabe, Akira Toki, Yasuhisa Sato, Kaoru Ogura,
Sae Yamamoto
J Hep Bil Pancr Surg 3:417-422, 1996
Choledochal cyst is often associated with pancreatobiliary
malunion, and pancreatic juice usually refluxes into the bile duct via the
malunion. Various pathological conditions develop in the biliary tract,
pancreas, and liver: cholangitis, biliary dilatation, biliary perforation,
biliary cancer, acute pancreatitis, and/or biliary cirrhosis. The performance
of cystenterostomy has recently been abandoned because of high morbidity
after surgery. Accurate delineation of the biliary tree and the pancreatobiliary
junction obtained by endoscopic retrograde cholangiopancreatography or operative
cholangiography is necessary. Cyst excision should be performed to prevent
ascending cholangitis and biliary cancer. Many types of procedures are employed
in biliary reconstruction, but free drainage of bile is imperative for preventing
cholangitis and stone formation. This can be achieved only by a wide anastomosis
performed at the hilum after ductoplasty.
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