Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Long-term complications after extrahepatic cyst excision for type IV-A choledochal cysts

  • Utpal Anand (Department of Surgical Gastroenterology, All India Institute of Medical Sciences) ;
  • Aaron George John (Department of Surgical Gastroenterology, All India Institute of Medical Sciences) ;
  • Rajeev Nayan Priyadarshi (Department of Radiodiagnosis, All India Institute of Medical Sciences) ;
  • Ramesh Kumar (Department of Medical Gastroenterology, All India Institute of Medical Sciences) ;
  • Basant Narayan Singh (Department of Surgical Gastroenterology, All India Institute of Medical Sciences) ;
  • Kunal Parasar (Department of Surgical Gastroenterology, All India Institute of Medical Sciences) ;
  • Bindey Kumar (Department of Pediatric Surgery, All India Institute of Medical Sciences)
  • Received : 2023.02.15
  • Accepted : 2023.03.28
  • Published : 2023.11.30
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Abstract

Forty-five adults with type IV-A choledochal cysts (CDC) who underwent extrahepatic cyst excision from January 2013 to December 2021 were followed up for a median interval of 25 months (range, 2 to 10 years) to observe the long-term complications in the remaining intrahepatic cyst. Late complications in varying combinations were seen in 10 patients, which included cholangitis and/or intrahepatic stones in 9 patients, intrahepatic bile duct stenosis with stones in 2 patients, anastomotic stricture in 6 patients, and left lobar atrophy with intrahepatic stones in 3 patients. Out of 6 patients who required re-do hepaticojejunostomy (HJ), three patients had left lobe atrophy with patent HJ anastomosis and a recurrent attack of cholangitis on follow-up at 3, 8, and 10 years. Complications occur frequently after extrahepatic cyst excision for type IV-A CDC and require a long-term follow-up.

Keywords

References

  1. Todani T, Watanabe Y, Fujii T, Toki A, Uemura S, Koike Y. Congenital choledochal cyst with intrahepatic involvement. Arch Surg 1984;119:1038-1043.
  2. Khandelwal C, Anand U, Kumar B, Priyadarshi RN. Diagnosis and management of choledochal cysts. Indian J Surg 2012;74:29-34.
  3. Anand U, Priyadarshi RN, Kumar B, Khandelwal C. Diagnosis and management of giant choledochal cysts: complexities compared to smaller cysts. Indian J Gastroenterol 2013;32:262-267.
  4. Chijiiwa K, Komura M, Kameoka N. Postoperative follow-up of patients with type IVA choledochal cysts after excision of extrahepatic cyst. J Am Coll Surg 1994;179:641-645.
  5. Ohi R, Yaoita S, Kamiyama T, Ibrahim M, Hayashi Y, Chiba T. Surgical treatment of congenital dilatation of the bile duct with special reference to late complications after total excisional operation. J Pediatr Surg 1990;25:613-617.
  6. Yamataka A, Ohshiro K, Okada Y, Hosoda Y, Fujiwara T, Kohno S, et al. Complications after cyst excision with hepaticoenterostomy for choledochal cysts and their surgical management in children versus adults. J Pediatr Surg 1997;32:1097-1102.
  7. Kim JH, Choi TY, Han JH, Yoo BM, Kim JH, Hong J, et al. Risk factors of postoperative anastomotic stricture after excision of choledochal cysts with hepaticojejunostomy. J Gastrointest Surg 2008;12:822-828.
  8. Ando H, Ito T, Kaneko K, Seo T. Congenital stenosis of the intrahepatic bile duct associated with choledochal cysts. J Am Coll Surg 1995;181:426-430.
  9. Yoshikawa K, Yoshida K, Shirai Y, Sato N, Kashima Y, Coutinho DS, et al. A case of carcinoma arising in the intrapancreatic terminal choledochus 12 years after primary excision of a giant choledochal cyst. Am J Gastroenterol 1986;81:378-384. Erratum in: Am J Gastroenterol 1986;81:844.
  10. Watanabe Y, Toki A, Todani T. Bile duct cancer developed after cyst excision for choledochal cyst. J Hepatobiliary Pancreat Surg 1999;6:207-212.
  11. Visser BC, Suh I, Way LW, Kang SM. Congenital choledochal cysts in adults. Arch Surg 2004;139:855-860; discussion 860-862.