A Single-Center Experience with 73 Patients of Adult Choledochal Cyst: An Indian Perspective

Abstract

Background: Aim of the study was to analyze the clinicopathological profile and long-term operative outcomes of patients with choledochal cysts (CDC) undergoing cyst excision. Methods: Clinical data of 73 adult CDC patients managed at a single tertiary care center between January 2010 and December 2016 were retrospectively analyzed. Patients who had undergone complete cyst excision and with a minimum follow-up of 12 months were included for long-term outcome analysis. Results: The male female ratio was approximately 1:3 and the median age was 35 years (range, 12-65 years). Type I CDC was the most common cyst type in this series (n=49/73, 67.1%). Abdominal pain was the commonest presenting symptom followed by jaundice, fever and palpable lump. Coexisting gallbladder carcinoma was encountered in 4/73 (5.48%) patients while two patients had secondary biliary cirrhosis with portal hypertension. Complete cyst excision was performed in 65 out of 73(89.0%) patients. Patients undergoing complete cyst excision were followed-up for a median duration of 29.5 months (range, 12-70 months). One case of hepaticojejunostomy stricture and two cases of post-operative incisional hernia were reported. No new case of cholangiocarcinoma was reported in any of our patients. Conclusion: Adulthood CDC are associated with an increased incidence of complications like recurrent cholangitis, pancreatitis and cyst perforation. The lesser association of biliary tract malignancy in Indian population may possibly be linked to a lower incidence of abnormal pancreaticobiliary duct junction. Complete cyst excision with hepaticojejunostomy remains the standard treatment both to relieve the symptoms and to minimize the risk of malignancy.

Management of Biliary Cysts in Adults: A Single-Center 10-Year Experience

“…Other reported hypotheses include oligoganglionosis of the biliary tree, partial biliary obstruction, ductal plate malformation, and sphincter of Oddi dysfunction [3,9,10]. In our study, we found APBDU in 6.6% of the patients only.…”

“…The majority of complications were wound-related, with anastomotic leaks followed by pancreatic fistula in the early phase. In the late phase, anastomotic strictures, cholangitis, adhesive intestinal obstruction, and malignancy were reported [10,12]. The risk of malignancy in biliary cysts exists even after the complete surgical excision, as reported in Korean and Japanese studies, but it was virtually nil in Indian studies so far, which can be attributed to the low incidence of APDBU, complete excision of cyst rather than drainage procedures, and shorter long-term follow-up [10].…”

“…In the late phase, anastomotic strictures, cholangitis, adhesive intestinal obstruction, and malignancy were reported [10,12]. The risk of malignancy in biliary cysts exists even after the complete surgical excision, as reported in Korean and Japanese studies, but it was virtually nil in Indian studies so far, which can be attributed to the low incidence of APDBU, complete excision of cyst rather than drainage procedures, and shorter long-term follow-up [10]. In our study, the early complication rate was 23.3% and no late complications were recorded with a median follow-up of 25 months.…”