title: Diagnosis and management experience of adult choledochal cysts: reasons for reoperation.
abstract: OBJECTIVE
  This study aims to summarize the diagnosis and management experience of adult choledochal cyst (CC) patients and highlights our experience of reoperation cases.
  
  
  METHODS
  The clinical data of 65 adult patients with CCs at the Second Affiliated Hospital of Chongqing Medical University between 2007 and 2011 were analyzed retrospectively.
  
  
  RESULTS
  According to Todani’s classification, there were 40 patients who belonged to type I, 1 patient to type II, 23 patients to type IVa, and 1 patient to type V cysts. Of all the patients, there were 24 patients who needed reoperation. Of the 24 patients, 17 patients had previously obtained erroneous diagnosis, 2 patients had undergone suboptimal treatment, and 5 patients had undergone definitive surgery. Forty-six patients underwent extrahepatic bile duct (EHBD) dilatation resection plus Roux-en-Y hepaticojejunostomy (HJ), 16 patients underwent partial hepatectomy plus EHBD resection plus Roux-en-Y HJ, 1 patient underwent partial hepatectomy, 1 patient underwent external drainage only, and 1 patient underwent reconstruction of hepatoenteric anastomosis by excision of stenosis.
  
  
  CONCLUSIONS
  Four reasons could account for reoperation: misdiagnosis, severe associated preoperative diseases, severe complications and inappropriate surgical procedures. Complete excision of the cyst including the intrahepatic part plus Roux-en-Y hepaticojejunostomy is the ideal surgical strategy.
authors.affiliation: Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: You
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Gong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D002681:China; D015529:Choledochal Cyst / Q000175:diagnosis* / Q000601:surgery*; D015897:Comorbidity; D003951:Diagnostic Errors; D003952:Diagnostic Imaging / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004322:Drainage; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D011237:Predictive Value of Tests; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D055815:Young Adult