Different Operative Procedure For Adult Patients With Congenital Choledochal Cysts

Objective To evaluate the surgical procedure for adult patients with congenital choledochal cysts accompanied with different correlative disease. Methods Analysed 64 cases from 1979 to 2006, all the cases were confirmed diagnosis through imagine test such as B ultrasonic, CT, MRCP, ERCP, cholangiography and (or) dissection, and 58/64 cases complicated with anomalous junction of pancreaticobiliary ductal system. Three types procedure were performed: 8 /64 cases accepted external drainage, 7/8cases accepted endoscopic nasobiliary drainage (ENBD), 7/64 cases received internal drainage. 57/64 cases accepted cyst excision with cystojejunal Roux-en-Y anastomosis. 13/57 patients received more than twice operations. Results ENBD or external drainage was helpful in emergency case, internal drainage frequently resulted in recurrent cholangitis, choledocholith, anastomotic stenosis or cyst malignancy which need reoperations treatment. Choledochocyst resection get good results and none reoperation. Conclusions Congenital choledochal cysts constantly complicated with anomalous junction of pancreaticobiliary ductal system (AJPBDS), the standard surgical method nowadays is the excision of the entire extrahepatic duct with a Roux-on-Y hepatojejunostomy, pancreatiobiliary shunt and hepatojejunostomy should be the basic therapeutic theory. Different operative procedures should be in different cases. ENBD should be the first treatment for the patient with acute cholangitis.