Yu You1, Jian-Ping Gong. 1. Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Abstract
BACKGROUND/AIMS: This study aims to summarize the diagnosis and management experience of adult choledochal cyst (CC) patients and highlights our experience of reoperation cases. METHODOLOGY: The clinical data of 65 adult patients with CCs at the Second Affiliated Hospital of Chongqing Medical University between 2007 and 2011 were analyzed retrospectively. RESULTS: According to Todani’s classification, there were 40 patients who belonged to type I, 1 patient to type II, 23 patients to type IVa, and 1 patient to type V cysts. Of all the patients, there were 24 patients who needed reoperation. Of the 24 patients, 17 patients had previously obtained erroneous diagnosis, 2 patients had undergone suboptimal treatment, and 5 patients had undergone definitive surgery. Forty-six patients underwent extrahepatic bile duct (EHBD) dilatation resection plus Roux-en-Y hepaticojejunostomy (HJ), 16 patients underwent partial hepatectomy plus EHBD resection plus Roux-en-Y HJ, 1 patient underwent partial hepatectomy, 1 patient underwent external drainage only, and 1 patient underwent reconstruction of hepatoenteric anastomosis by excision of stenosis. CONCLUSIONS: Four reasons could account for reoperation: misdiagnosis, severe associated preoperative diseases, severe complications and inappropriate surgical procedures. Complete excision of the cyst including the intrahepatic part plus Roux-en-Y hepaticojejunostomy is the ideal surgical strategy.
BACKGROUND/AIMS: This study aims to summarize the diagnosis and management experience of adult choledochal cyst (CC) patients and highlights our experience of reoperation cases. METHODOLOGY: The clinical data of 65 adult patients with CCs at the Second Affiliated Hospital of Chongqing Medical University between 2007 and 2011 were analyzed retrospectively. RESULTS: According to Todani’s classification, there were 40 patients who belonged to type I, 1 patient to type II, 23 patients to type IVa, and 1 patient to type V cysts. Of all the patients, there were 24 patients who needed reoperation. Of the 24 patients, 17 patients had previously obtained erroneous diagnosis, 2 patients had undergone suboptimal treatment, and 5 patients had undergone definitive surgery. Forty-six patients underwent extrahepatic bile duct (EHBD) dilatation resection plus Roux-en-Y hepaticojejunostomy (HJ), 16 patients underwent partial hepatectomy plus EHBD resection plus Roux-en-Y HJ, 1 patient underwent partial hepatectomy, 1 patient underwent external drainage only, and 1 patient underwent reconstruction of hepatoenteric anastomosis by excision of stenosis. CONCLUSIONS: Four reasons could account for reoperation: misdiagnosis, severe associated preoperative diseases, severe complications and inappropriate surgical procedures. Complete excision of the cyst including the intrahepatic part plus Roux-en-Y hepaticojejunostomy is the ideal surgical strategy.