Diagnosis And Management Experience Of Adult Choledochal Cyst: The Reason Of Reoperation

Purpose: Aim of this study is to summarize the diagnosis andmanagement experience of adult choledochal cysts patients and highlightsour experience of the reoperation cases.Methods: The clinical data of65adult patients with choledochal cystsat the Second Affiliated Hospital of Chongqing Medical Universitybetween2007and2011are analyzed retrospectively.Results: According to Todani’s classification, there were40patientswho belonged to type I,1patient to type II,23patients to type IVa, and1patient to type V cysts. Of all the patients, there were24patients whoneeded reoperation. Of the24patients,17patients previously got erroneousdiagnosis,2patients had undergone suboptimal treatment，and5patientshad undergone definitive surgery. Forty-six patients underwent extrahepaticbile duct (EHBD) resection plus hepaticojejunostomy (HJ), seventeenpatients underwent partial hepatectomy plus EHBD resection plusRoux-en-Y HJ, one patient underwent external drainage only, and one patient underwent reconstruction of hepatoenteric anastomosis by excisionof stenosis. Intrahepatic stones were found in8patients and malignantchange was found in4patients. There was one anastomotic leak and noperioperative death. Three of the four malignancy-found patients died. Ofall the65patients, the overall late complication rate was12.3%(8/65).Conclusion: Three reasons could account for the reoperation:misdiagnosis of CCs, severe associated preoperative complication andinappropriate surgical procedure. Complete excision of the cyst andRoux-en-Y HJ is the ideal surgical strategy while sometimes completeresection of the intrahepatic bile duct dilatation (IHBD) with partialhepatectomy should be recommended for adult type IV patients, especiallythe old patients.