Selection of the surgical approach for reoperation of adult choledochal cysts.
OBJECTIVE
Our purpose was to evaluate the reasons for reoperations and outcomes in patients with choledochal cysts (CCs).


METHODS
The records of patients with CCs who underwent reoperations from 1995 to 2012 were retrospectively reviewed.


RESULTS
Of 165 patients with a mean age of 42.54 ± 14.05 years, 62 had Todani type I (37.6 %), 84 type IV-A (50.9 %), and 19 had unknown type CCs (11.5 %). Previous surgery was internal or external drainage alone in 66.1 % of patients with type I and 23.8 % of patients with type IV-A CCs. Partial cyst excision and Roux-en-Y cyst-jejunostomy or cyst excision and choledochoplasty by jejunal interposition were performed in 16.1 and 11.3 % of patients with type I and IV-A CCs, respectively. Reoperations at our hospital were maximal cyst excision and Roux-en-Y hepaticojejunostomy. Radical cyst excision was achieved in 93.5 % of patients with type I and 44.0 % of patients with type IV-A CCs. With an average follow-up of 48.23 ± 12.30 months, recurrent cholangitis and biliary-enteric anastomotic stenosis occurred in 18 (13.2 %) and 9 patients (6.6 %), respectively. Long-term biliary function was excellent or good in 83.8 % of patients.


CONCLUSIONS
Radical cyst excision and Roux-en-Y hepaticojejunostomy provide good outcomes in patients with CCs.
Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 100853, Beijing, China, Xiahongtian115@sina.com.
Hong-Tian
HT
Xia
Jia-Hong
JH
Dong
Tao
T
Yang
Bin
B
Liang
Jian-Ping
JP
Zeng
D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects; D002761:Cholangitis / Q000209:etiology; D015529:Choledochal Cyst / Q000145:classification / Q000150:complications / Q000601:surgery*; D004322:Drainage; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult