Long-term outcomes after extrahepatic excision of congenital choladocal cysts: 30 years of experience at a single center.
OBJECTIVE
Congenital choladocal cysts are generally treated by resection of the dilated extrahepatic biliary duct followed by hepaticojejunostomy, but it is associated with postoperative complications, including postoperative cholangitis, intrahepatic calculi, pancreatitis, and carcinogenesis, in the remnant bile duct. We investigated the most common long-term complications and identified the factors implicated in their development.


METHODS
We conducted a retrospective review and analysis of the long-term complications of 65 patients surgically treated for congenital choledochal cysts between 1978 and 2008 at one institute. The risk factors for intrahepatic calculi were identified based on the odds ratios of the implicated variables.


RESULTS
Cholangitis with high fever or abdominal pain was reported in 14 patients (21.5%), intrahepatic calculi in 12 (18.5%), pancreatitis in 3 (4.6%), and cholangiocarcinoma in 3 (4.6%). Diagnosis with type IVa choledochal cysts was the most significant risk factor, followed by age ≥30 years at the time of treatment, and the presence of preoperative intrahepatic calculi.


CONCLUSIONS
While precise and thorough surgical treatment is necessary to prevent the long-term development of complications after surgical excision of congenital choledochal cysts, it must be accompanied by long-term postoperative follow-up, especially of elderly patients and those with type IVa cysts.
Hideo
H
Ohtsuka
Koji
K
Fukase
Hiroshi
H
Yoshida
Fuyuhiko
F
Motoi
Hiroki
H
Hayashi
Takanori
T
Morikawa
Takaho
T
Okada
Kei
K
Nakagawa
Takeshi
T
Naitoh
Yu
Y
Katayose
Michiaki
M
Unno
D000293:Adolescent; D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D015529:Choledochal Cyst / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007564:Japan; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult