Intraoperative endoscopy during choledochal cyst excision: extended long-term follow-up compared with recent cases.
BACKGROUND
We routinely perform intraoperative endoscopy (IOE) of the intrahepatic bile duct (IHBD) and intrapancreatic bile duct (IPBD) with a pediatric cystoscope during excision of choledochal cyst (CC). Here we compare extended long-term follow-up patients with a series of recent cases.


METHODS
We compared 25 CC patients treated over the past 5 years (group 1) with 69 CC patients treated between 1986 and 1998 and followed up for more than 10 years (group 2), focusing on stone formation.


RESULTS
In group 1 (mean follow-up, 2.6 years) IOE identified IHBD debris in 7 (28%) of 25 and IPBD protein plugs in 9 (36%) of 25. In group 2 (mean follow-up, 14.6 years) IOE identified IHBD debris in 11 (16%) of 69 and IPBD protein plugs in 17 (25%) of 69. There was no relation between type of CC and incidence of IHBD debris or IPBD protein plugs. The incidence of postoperative stones to date is 0% in group 1 and 2.9% in group 2, rates far lower than those reported in the literature.


CONCLUSIONS
We attribute our lower incidence of stones directly to IOE and recommend that it be performed routinely during cyst excision. It is simple, is effective, and improves outcome.
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Tsubasa
T
Takahashi
Akihiro
A
Shimotakahara
Tadaharu
T
Okazaki
Hiroyuki
H
Koga
Go
G
Miyano
Geoffrey J
GJ
Lane
Yoshifumi
Y
Kato
Atsuyuki
A
Yamataka
D000293:Adolescent; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods; D015529:Choledochal Cyst / Q000175:diagnosis / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007430:Intraoperative Care / Q000379:methods*; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods; D016896:Treatment Outcome