title: Choledochal cyst: A review of 79 cases and the role of hepaticodochoduodenostomy.
abstract: OBJECTIVE
  To analyze our experience of choledochal cysts. The results of complete excision of cyst and hepaticodochoduodenostomy have been analyzed in particular.
  
  
  METHODS
  
  
  
  METHODS
  January 1993 to August 2010. Apart from basic investigations, we did ultrasonography (USG) of abdomen, contrast-enhanced computerized axial tomography scan (CECT), endoscopic retrograde cholangiopancreatography (ERCP), operative cholangiogram, hepatic isotope scan (HIDA), magnetic resonance cholangiopancreatogram (MRCP) and choledochoscopy. The patients were divided into six groups according to the management done and the results analyzed.
  
  
  RESULTS
  The total number of cases was 79 (Male : Female = 26 : 53). The mean age of presentationwas 5.18 years. The most common mode of presentation was abdominal pain in 86% cases. Types of cysts - Type I: 63; Type IV: 12; Forme fruste: 1; Caroli's disease: 1; Cyst with atresia in the lower end of common bile duct: 2. Two patients of group A (cyst excision and Roux-en-Y hepaticojejunostomy) had recurrent pain and cholangitis. One patient required revision for stricture. In group E (n=53) (excision of cyst and hepaticodochoduodenostomy), three patients developed occasional epigastric pain and they responded to omeprazole. One patient developed anastomotic stricture and was lost to follow up. One patient of cyst with biliary atresia with biliary cirrhosis died.
  
  
  CONCLUSIONS
  In choledochal cyst, complete excision of cyst and good bilioenteric anastomosis with wide stoma should be done. Hepaticodochoduodenostomy with wide stoma is a simple, quick procedure with preservation of normal anatomy and physiology and minimum complications. It also avoids multiple intestinal anastomoses and so should be the preferred approach.
authors: Department of Pediatric Surgery, N R S Medical College, Kolkata - 700 014, India.
authors: Biswanath
authors: B
authors: Mukhopadhyay
authors: Ram Mohan
authors: RM
authors: Shukla
authors: Madhumita
authors: M
authors: Mukhopadhyay
authors: Kartik Chandra
authors: KC
authors: Mandal
authors: Partha Pratik
authors: PP
authors: Mukherjee
authors: Dipankar
authors: D
authors: Roy
authors: Sumitra Kumar
authors: SK
authors: Biswas
authors: Kalyani Saha
authors: KS
authors: Basu