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  • Title: Intraoperative endoscopy during choledochal cyst excision: extended long-term follow-up compared with recent cases.
    Author: Takahashi T, Shimotakahara A, Okazaki T, Koga H, Miyano G, Lane GJ, Kato Y, Yamataka A.
    Journal: J Pediatr Surg; 2010 Feb; 45(2):379-82. PubMed ID: 20152356.
    Abstract:
    INTRODUCTION: We routinely perform intraoperative endoscopy (IOE) of the intrahepatic bile duct (IHBD) and intrapancreatic bile duct (IPBD) with a pediatric cystoscope during excision of choledochal cyst (CC). Here we compare extended long-term follow-up patients with a series of recent cases. METHODS: We compared 25 CC patients treated over the past 5 years (group 1) with 69 CC patients treated between 1986 and 1998 and followed up for more than 10 years (group 2), focusing on stone formation. RESULTS: In group 1 (mean follow-up, 2.6 years) IOE identified IHBD debris in 7 (28%) of 25 and IPBD protein plugs in 9 (36%) of 25. In group 2 (mean follow-up, 14.6 years) IOE identified IHBD debris in 11 (16%) of 69 and IPBD protein plugs in 17 (25%) of 69. There was no relation between type of CC and incidence of IHBD debris or IPBD protein plugs. The incidence of postoperative stones to date is 0% in group 1 and 2.9% in group 2, rates far lower than those reported in the literature. CONCLUSIONS: We attribute our lower incidence of stones directly to IOE and recommend that it be performed routinely during cyst excision. It is simple, is effective, and improves outcome.
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