Preoperative classification based on intrahepatic bile duct morphology for predicting postoperative complications in congenital biliary dilatation.

BACKGROUND

Late postoperative complications of congenital biliary dilatation include intrahepatic bile duct stones, cholangitis, and cholangiocarcinoma. This study aimed to establish a preoperative classification system using intrahepatic bile duct morphology and evaluate its effectiveness in predicting postoperative complications.

METHODS

This retrospective study reviewed 196 patients who underwent radical congenital biliary dilatation surgery between 2003 and 2022. Patients were classified into 3 risk groups based on preoperative cholangiopancreatography findings of intrahepatic bile duct morphology: risk type-low, no intrahepatic bile duct dilatation; risk type-intermediate, intrahepatic bile duct dilatation without downstream bile duct stenosis, but including stenosis at the hilar region; risk type-high, intrahepatic bile duct dilatation with downstream bile duct stenosis, including stenosis at the hilar region and more peripherally than the secondary branches.

RESULTS

The incidence of intrahepatic bile duct stones was significantly higher in risk type-high (n = 9, 53%) (P < .001) compared with risk type-low (0%) and risk type-intermediate (n = 3, 2.8%). The incidence of cholangitis was significantly higher in risk type-high (n = 9, 53%) (P < .001) compared with risk type-low (n = 3, 4.3%) and risk type-intermediate (n = 3, 2.8%). No cases of cholangiocarcinoma were observed. Patients with risk type-high who did not improve with double-balloon endoscopic retrograde cholangiography required percutaneous transhepatic biliary drainage or hepatectomy.

CONCLUSIONS

Our newly proposed preoperative classification system is effective in predicting postoperative complications in congenital biliary dilatation patients. Patients classified as risk type-high require careful postoperative follow-up, particularly when intraoperative bile ductoplasty fails to relieve stenosis. Identifying high-risk cases preoperatively may help improve long-term surgical outcomes.