Whether or not prophylactic excision of the extrahepatic bile duct is appropriate for patients with pancreaticobiliary maljunction without bile duct dilatation.
OBJECTIVE
The standard treatment for patients with a pancreaticobiliary maljunction (PBM) without bile duct dilatation remains controversial.


METHODS
We followed up 29 patients with such PBM who mainly underwent a cholecystectomy alone. The ages of the patients ranged from 3 to 76 years (average age 47.3 years) and the ratio of males to females was 8 vs. 21. When the diameter of the common bile duct was less than 10mm, such bile ducts were diagnosed to have no dilatation. The main clinical indications for surgery were cholecystolithiasis in 15 patients, choledocholithiasis in 3, cholecystocholedocholithiasis in 2, gallbladder polyp in 2, adenomyomatosis in 2, cholecystitis in 2, and protein plug in 1.


RESULTS
The amylase levels of gallbladder bile in 20 patients ranged from 115 to 460,200 IU/mL (a mean of 191,698 IU/mL). One patient died of gastric cancer 182 months after surgery and two patients died of other diseases 153, 171 months after surgeries, respectively. The remaining 26 patients have all been doing well for 36 months to 326 months after surgery (a median follow-up period, 160.5 months). The 10- and 15-year survival rates were 100% and 89.7%.


CONCLUSIONS
In conclusion, a prophylactic resection of the extrahepatic bile duct and biliary diversion could be unnecessary for patients with PBM without bile duct dilatation.
Kusano
T
T
Department of Surgery, Shin-Koga-Hospital, Kurume, Japan. kusano@toq.ne.jp
Takao
T
T
Tachibana
K
K
Tanaka
Y
Y
Kamachi
M
M
Ikematsu
Y
Y
Nishiwaki
Y
Y
Kida
H
H
Waki
S
S
Uchimura
M
M
Furukawa
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D001659:Biliary Tract / Q000002:abnormalities*; D001661:Biliary Tract Neoplasms / Q000517:prevention & control; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D015331:Cohort Studies; D004106:Dilatation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome