[Congenital dilatation of the common bile duct in children. Study of a series of 52 cases].
OBJECTIVE
The aim of this study was to evaluate results at long-term follow-up of patients suffering from congenital dilatation of the bile duct according to the type of operative procedure.


METHODS
A retrospective study of 52 patients who were operated on during a 25-year period was carried out. Of 52 patients, 43 (83%) were female and 9 (17%) were male, with a ratio of 4.8/1. In six cases, the diagnosis was made antenatally by ultrasonography. Transhepatic cholangiography showed an extrahepatic dilatation in 25 cases (48%) and a combined extra and intrahepatic dilatation in 27 cases (52%). A common bilio-pancreatic channel was found in 25 patients. Mean age at the time of operation was 4.2 years. Operative procedures included: cyst excision and hepaticojejunostomy in 47 cases, cystojejunostomy or cystoduodenostomy in 4 cases and cystostomy in one case. There were two postoperative deaths.


RESULTS
Long-term follow-up was established in 43 of 50 survivors (80%). One patient was reoperated because of portal hypertension. Cholangitis developed in 11 patients: 2/2 patients who had undergone in internal drainage and 9/41 patients who had undergone a cyst excision with hepaticojejunostomy. In patients with cyst excision, cholangitis developed twice as frequently in those with associated intrahepatic dilatation. Two of 11 children with recurrent cholangitis died following sepsis, and three others were reoperated because of intrahepatic bile duct stones, one of these 15 years later.


CONCLUSIONS
A total excision of the extrahepatic biliary tract, followed by hepaticojejunostomy is considered as a treatment of choice. The site of the biliary anastomosis should be adapted to the type of dilatation of intrahepatic bile duct in the case of a combined extra and intrahepatic dilatation.
Nguyen
T L
TL
Service de Chirurgie pédiatrique, Hôpital de Bicêtre, Le Kremlin-Bicêtre.
Valayer
J
J
D000293:Adolescent; D000713:Anastomosis, Roux-en-Y; D017734:Bile Ducts, Extrahepatic / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003135:Common Bile Duct / Q000601:surgery; D003137:Common Bile Duct Diseases / Q000151:congenital* / Q000601:surgery; D004108:Dilatation, Pathologic / Q000151:congenital* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007582:Jejunostomy; D008099:Liver / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors
Dilatation congénitale de la voie biliaire principale chez l'enfant. Etude d'une série de 52 cas.