Diagnosis and management experience of adult choledochal cysts: reasons for reoperation.

BACKGROUND/AIMS: This study aims to summarize the diagnosis and management experience of adult choledochal cyst (CC) patients and highlights our experience of reoperation cases.

METHODOLOGY: The clinical data of 65 adult patients with CCs at the Second Affiliated Hospital of Chongqing Medical University between 2007 and 2011 were analyzed retrospectively.

RESULTS

According to Todani’s classification, there were 40 patients who belonged to type I, 1 patient to type II, 23 patients to type IVa, and 1 patient to type V cysts. Of all the patients, there were 24 patients who needed reoperation. Of the 24 patients, 17 patients had previously obtained erroneous diagnosis, 2 patients had undergone suboptimal treatment, and 5 patients had undergone definitive surgery. Forty-six patients underwent extrahepatic bile duct (EHBD) dilatation resection plus Roux-en-Y hepaticojejunostomy (HJ), 16 patients underwent partial hepatectomy plus EHBD resection plus Roux-en-Y HJ, 1 patient underwent partial hepatectomy, 1 patient underwent external drainage only, and 1 patient underwent reconstruction of hepatoenteric anastomosis by excision of stenosis.

CONCLUSIONS

Four reasons could account for reoperation: misdiagnosis, severe associated preoperative diseases, severe complications and inappropriate surgical procedures. Complete excision of the cyst including the intrahepatic part plus Roux-en-Y hepaticojejunostomy is the ideal surgical strategy.