title: Postnatal management for prenatally diagnosed choledochal cysts.
abstract: OBJECTIVE
  The aim of this study was to determine an appropriate postnatal management plan for prenatally diagnosed congenital biliary dilatation (CBD).
  
  
  METHODS
  Between 1962 and 2002, 5 (5.9 %) of 85 patients had CBD diagnosed prenatally and were examined clinically. Of these 5 patients, 2 (group A) underwent delayed primary definitive surgery after percutaneous transhepatic cholangiodrainage (PTCD), 1 (group B) underwent early definitive surgery in the neonatal period, and 2 (group C) underwent delayed primary definitive surgery without PTCD in early infancy (within 6 months after birth). The clinical data, operative findings, intra- and postoperative complications, and follow-up were evaluated in these 3 groups.
  
  
  RESULTS
  There were no postoperative complications, such as catheter-related complications, in group A. However, there was adhesion around the choledochal cyst, and the operation was therefore difficult in group A. The diameter of the anastomosis in the hepaticojejunostomy was small, and the cyst wall was thin in group B. Consequently, anastomotic leakage of the hepaticojejunostomy occurred in group B. Neither operative nor postoperative complications such as anastomotic leakage or stenosis occurred in group C. Slight fibrosis of Glisson's sheath was seen in 2 patients of groups A and C. No liver cirrhosis was seen in any group.
  
  
  CONCLUSIONS
  The authors propose that asymptomatic patients should undergo elective definitive surgery by 6 months of age. For symptomatic patients, especially when a differential diagnosis of type I cystic biliary atresia is doubtful, early definitive surgery is needed before 2 months of age. PTCD appears to be indicated only under certain circumstances, and delayed primary definitive surgery should be performed as early as possible thereafter.
authors.affiliation: Department of Pediatric Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Okada
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Sasaki
authors.forename: Shinya
authors.initials: S
authors.lastname: Ueki
authors.forename: Gentarou
authors.initials: G
authors.lastname: Hirokata
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Okuyama
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Cho
authors.forename: Satoru
authors.initials: S
authors.lastname: Todo
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D001706:Biopsy; D015529:Choledochal Cyst / Q000000981:diagnostic imaging* / Q000196:embryology / Q000601:surgery*; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology; D016216:Ultrasonography, Prenatal