title: Impact of previous cyst-enterostomy on patients' outcome following resection of bile duct cysts.
abstract: OBJECTIVE
  To analyze the impact of previous cyst-enterostomy of patients underwent congenital bile duct cysts (BDC) resection.
  
  
  METHODS
  A multicenter European retrospective study between 1974 and 2011 were conducted by the French Surgical Association. Only Todani subtypes I and IVb were included. Diagnostic imaging studies and operative and pathology reports underwent central revision. Patients with and without a previous history of cyst-enterostomy (CE) were compared.
  
  
  RESULTS
  Among 243 patients with Todani types I and IVb BDC, 16 had undergone previous CE (6.5%). Patients with a prior history of CE experienced a greater incidence of preoperative cholangitis (75% vs 22.9%, P < 0.0001), had more complicated presentations (75% vs 40.5%, P = 0.007), and were more likely to have synchronous biliary cancer (31.3% vs 6.2%, P = 0.004) than patients without a prior CE. Overall morbidity (75% vs 33.5%; P < 0.0008), severe complications (43.8% vs 11.9%; P = 0.0026) and reoperation rates (37.5% vs 8.8%; P = 0.0032) were also significantly greater in patients with previous CE, and their Mayo Risk Score, during a median follow-up of 37.5 mo (range: 4-372 mo) indicated significantly more patients with fair and poor results (46.1% vs 15.6%; P = 0.0136).
  
  
  CONCLUSIONS
  This is the large series to show that previous CE is associated with poorer short- and long-term results after Todani types I and IVb BDC resection.
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Ouaissi
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Emilia
authors.initials: E
authors.lastname: Ragot
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Remi
authors.initials: R
authors.lastname: Dubois
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Revillon
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Letoublon
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: François
authors.initials: F
authors.lastname: Paye
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rat
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjema
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Adeline
authors.initials: A
authors.lastname: Roux
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mabrut
authors.affiliation: Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Gigot
keywords: Bile duct cyst; Biliary disease; Congenital; Cyst-enterostomy; Long-term outcome