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  • Title: Selection of the surgical approach for reoperation of adult choledochal cysts.
    Author: Xia HT, Dong JH, Yang T, Liang B, Zeng JP.
    Journal: J Gastrointest Surg; 2015 Feb; 19(2):290-7. PubMed ID: 25373703.
    Abstract:
    BACKGROUND/PURPOSE: Our purpose was to evaluate the reasons for reoperations and outcomes in patients with choledochal cysts (CCs). METHODS: The records of patients with CCs who underwent reoperations from 1995 to 2012 were retrospectively reviewed. RESULTS: Of 165 patients with a mean age of 42.54 ± 14.05 years, 62 had Todani type I (37.6 %), 84 type IV-A (50.9 %), and 19 had unknown type CCs (11.5 %). Previous surgery was internal or external drainage alone in 66.1 % of patients with type I and 23.8 % of patients with type IV-A CCs. Partial cyst excision and Roux-en-Y cyst-jejunostomy or cyst excision and choledochoplasty by jejunal interposition were performed in 16.1 and 11.3 % of patients with type I and IV-A CCs, respectively. Reoperations at our hospital were maximal cyst excision and Roux-en-Y hepaticojejunostomy. Radical cyst excision was achieved in 93.5 % of patients with type I and 44.0 % of patients with type IV-A CCs. With an average follow-up of 48.23 ± 12.30 months, recurrent cholangitis and biliary-enteric anastomotic stenosis occurred in 18 (13.2 %) and 9 patients (6.6 %), respectively. Long-term biliary function was excellent or good in 83.8 % of patients. CONCLUSIONS: Radical cyst excision and Roux-en-Y hepaticojejunostomy provide good outcomes in patients with CCs.
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