Hepaticoduodenostomy for Biliary Reconstruction After Surgical Resection of Choledochal Cyst: a 25-Year Experience

Patil, Vijay; Kanetkar, Vijay; Talpallikar, M. C.

doi:10.1007/s12262-012-0783-2

Cited by 11 publications

(20 citation statements)

References 14 publications

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“…[13][14][15] The incidence of APBDJ has been found to be low in major Indian series as well. 15,[24][25][26][27][28][29] In the present study, APBDJ was present 20% of patients, which is consistent with previous findings in Indian patients ( Table 7). The APBDJ is a known risk factor for biliary tract malignancy.The chronic pancreaticobiliary reflux incites inflammation in the gallbladder and bile duct mucosa, thus leading to dysplasia and malignant changes.…”

Section: Discussionsupporting

confidence: 91%

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

Kumar¹

2018

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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.

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Section: Discussionsupporting

confidence: 91%

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

Kumar¹

2018

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“…HD and RYHJ are the two most commonly utilized techniques of reconstruction [119], although other replacement conduits such as jejunal interposition HD, valved jejunal interposition HD, nonrefluxing biliary appendicoduodenostomy, hepaticoenterostomy, and wide hilar hepaticojejunostomy have been reported [120][121][122][123][124][125]. HD has been favored by some groups [126,127] but most series suggests significantly more bile reflux compared with RYHJ [121], which is currently the most commonly utilized reconstruction.…”

Section: Managementmentioning

confidence: 99%

“…Dilated bile ducts should be irrigated with heparinized saline to clear the gallstones before anastomosis. After the cyst is excised, one of the hepaticoenterostomy methods, such as hepaticojejunostomy, HD, jejunal interposition HD, valved jejunal interposition HD, nonrefluxing biliary appendicoduodenostomy, hepaticoenterostomy, and wide hilar hepaticojejunostomy [120][121][122][123][124][125] is performed for biliary reconstruction. In RYHJ, 40-cm jejunal loop replaces to the hepatic hilus.…”

Section: Open Surgerymentioning

confidence: 99%

“…The intraabdominal drain, kept in Morison's pouch, may be removed on the seventh postoperative day [124].…”

Section: Open Surgerymentioning

confidence: 99%

“…The most commonly performed operations for biliary reconstruction after complete surgical resection of CCs are RYHJ or HD [124]. There is a debate regarding the optimal technique for biliary reconstruction [124].…”

Section: The Optimal Technique For Biliary Reconstructionmentioning

confidence: 99%

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Pediatric Choledochal Cysts: Unknowns are Decreasing

Gezer¹

2019

Pediatric Surgery, Flowcharts and Clinical Algorithms

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Choledochal cysts (CCs) are congenital cystic dilatation of extrahepatic and/ or intrahepatic bile ducts. CCs are more common in Asian population, the cause is still unknown. Although the etiology is controversial, the main elements in the natural historical emergence of the type I and type IV, which make up the majority of all types, have become clearer. The majority of CCs are diagnosed in childhood. Clinical presentation varies from jaundice in young patients to nonspecific abdominal pain in older, but morbidity increases with complications such as cholangitis, pancreatitis, perforation, hepatitis, liver failure, and malignancy in delayed diagnosed patients. MRCP is considered the current gold standard diagnostic modality that is able to accurately assess biliary anatomy. Although the treatment approach has been formed over the years, it still has not reached the last state. Eventually, the removal of the entire cyst and the reconstruction of the remaining biliary tract to drainage is the current treatment approach. But the dilemma is the way of reconstruction procedure (hepaticoduodenostomy or hepaticojejunostomy). All patients should be followed up for a long period of time, regardless of the surgery method.

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