Outcomes of choledochal cysts with or without intrahepatic involvement in children after extrahepatic cyst excision and Roux-en-Y hepaticojejunostomy.
BACKGROUND
Type I and type IV-A choledochal cysts (CC) in Todani's classification are the most frequent types of CC. Unlike type I cyst, in which the dilatation is confined to the extrahepatic bile duct, type IV-A affects both extra and intrahepatic ducts.


OBJECTIVE
To review our experience of complete cyst excision with Roux-en-Y hepaticojejunostomy for the treatment of type I and type IV-A CC in childhood, in order to better characterize these entities.


METHODS
Data was collected retrospectively from a cohort of children who underwent cyst resection for CC from 1989 to 2011 in our institution.


RESULTS
Twelve patients were submitted to surgical excision of extrahepatic cyst and hepaticojejunostomy for treatment of type I (n = 6) and type IV-A (n = 6) cysts, with a complication rate of 25% (n = 3) and no mortality. Long term follow-up was available in 92% of patients, with a median of 10 years (2-22 years). Morbidities consisted of bile leak (2 patients) and late-onset cholestasis (1 patient); two of these required anastomotic revision. The results did not reveal any significant differences between the groups regarding postoperative outcomes (P > 0.05). Preoperative intrahepatic dilatation was found to permanently vanish in 83% of patients diagnosed with type IV-A cyst after operative repair.


CONCLUSIONS
Intrahepatic dilatation of type IV-A cyst in children did not adversely affect the postoperative outcome after conventional surgical repair. This operative approach was effective in the management of type I and type IV-A cysts.
Department of Pediatric Surgery, Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, EPE, Portugal.
Kisa
K
Congo
Maria Francelina
MF
Lopes
Patrícia H
PH
Oliveira
Hugo
H
Matos
Susana
S
Basso
Aurélio
A
Reis
D000367:Age Factors; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D017734:Bile Ducts, Extrahepatic / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000175:diagnosis / Q000601:surgery*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011174:Portugal; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome