Surgical outcomes after re-operation for excision of choledochal cyst with delayed biliary complications: A retrospective study on 40 patients

Ray, Sukanta; Dhali, Arkadeep; Khamrui, Sujan; Mandal, Tuhin Subhra; Das, Somak; Dhali, Gopal Krishna

doi:10.1016/j.amjsurg.2023.02.004

Cited by 2 publications

(4 citation statements)

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“…Unfortunately, despite radical treatment, early postoperative complications can occur and include ileus, bile leakage, pancreatitis, and pancreatic fistula. Late complications are rare, but tedious and multiple issues have been reported, from incisional hernias to biliary stricture, choledocholithiasis, and recurrent cholangitis, while between 0.7 and 10% of patients develop cholangiocarcinoma or pancreatic adenocarcinoma after surgery at variable intervals, even after several decades [ 10 , 13 , 50 , 51 , 52 ]. The largest retrospective study published so far reports on the long-term follow-up of 3911 patients who underwent CC resections, and the authors propose a life-long evaluation of patients, with an increase in the frequency of liver function tests and ultrasound assessments after the first 20 years following the initial resection [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…This poses real threats as CCs are precancerous lesions with a malignancy rate that ranges from 2.5% to 28%, according to different reports, and increases with age [ 8 , 9 ]. Moreover, postoperative complications can be serious and difficult to manage, and delayed biliary complications can arise as late as two decades after surgery [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Types IA, IC, and IVA are usually associated with a pancreaticobiliary maljunction [ 12 ]. Types I and IV have been repeatedly cited in both case reports and systematic reviews as having the highest potential for long-term postoperative complications, including intrahepatic bile duct dilatation, the development of intrahepatic calculi, cholangitis, strictures, and metachronous malignancy [ 10 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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The Curious Case of the Choledochal Cyst—Revisiting the Todani Classification: Case Report and Review of the Literature

et al. 2023

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Choledochal cysts (CCs) are rare occurrences presenting as dilatations of biliary structures, which can present as single or multiple dilatations and can appear as both intra- and extrahepatic anomalies. The most widespread classification of CCs is the Todani classification, but there have been numerous reports of cysts that do not fall into any of the types described. We present such a case—a male patient 36 years of age who underwent preoperative CT, MRCP, and ERCP, which mistakenly indicated a type II Todani CC, and intraoperatively was found to be located at the confluence of the hepatic ducts and encompassed the origin of the common bile duct. Complete resection of the cyst and the proximal segment of the common bile duct was performed, and reconstruction was carried out by Roux-en-Y double-tutorized hepaticojejunostomy. Considering the risk of malignant transformation, the frequent preoperative misdiagnosis, as well as the technically challenging surgery required in such cases, we advocate for a revision of the classification and raise awareness of the need for guidelines regarding the proper short-term and long-term management of this disease to ensure adequate quality of life and disease-free survival for patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Curious Case of the Choledochal Cyst—Revisiting the Todani Classification: Case Report and Review of the Literature

et al. 2023

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“…The most common long-term biliary complications are intrahepatic bile duct stones, biliary cirrhosis, and biliary intestinal anastomotic stenosis ( 7 ). Although the congenital factors including abnormal right artery and type IV bile duct cysts are more likely to induce anastomotic stenosis and intrahepatic bile duct stones ( 7 , 8 ), we also need to focus more on the technical factors such as incomplete cyst excision, failure of tension-free anastomosis, deficiency of vascular supply, insufficient anastomosis caliber and unresolved hilar or intrahepatic stenosis in type IVA cysts ( 9 ). For example, the occurrence of anastomotic stenosis after type I bile duct cyst surgery is mostly due to surgical technique.…”

Section: Discussionmentioning

confidence: 99%

Non-cirrhotic portal hypertension secondary to cholangiointestinal anastomotic stricture after choledochal cyst excision: a case report

et al. 2023

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BackgroundCystectomy accompanied by biliary system reconstruction is an important treatment option for choledochal cysts, but the risk of post-operative complications is high. The most famous long-term complication is anastomotic stricture, whereas non-cirrhotic portal hypertension secondary to cholangiointestinal anastomotic stricture is rare.Case summaryHere we report the case of a 33-year-old female patient with a type I choledochal cyst who underwent choledochal cyst excision with Roux-en-Y hepaticojejunostomy. Thirteen years later, the patient presented with severe esophageal and gastric variceal bleeding, splenomegaly, and hypersplenism. Furthermore, cholangiointestinal anastomotic stricture with cholangiectasis was identified on imaging. A pathological examination of the liver suggested intrahepatic cholestasis, but the fibrosis was mild and inconsistent with severe portal hypertension. Therefore, the final diagnosis was portal hypertension secondary to a cholangiointestinal anastomotic stricture after choledochal cyst surgery. Fortunately, the patient recovered well after endoscopic treatment and dilated cholangiointestinal anastomotic stricture.ConclusionCholedochal cyst excision with Roux-en-Y hepaticojejunostomy is the recommended standard of care for type I choledochal cysts; however, the long-term risk of cholangiointestinal anastomotic stricture requires consideration. Moreover, cholangiointestinal anastomotic stricture can lead to portal hypertension, and the degree of elevated portal pressure may be inconsistent with the degree of intrahepatic fibrosis.

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Surgical outcomes after re-operation for excision of choledochal cyst with delayed biliary complications: A retrospective study on 40 patients

Cited by 2 publications

References 39 publications

The Curious Case of the Choledochal Cyst—Revisiting the Todani Classification: Case Report and Review of the Literature

The Curious Case of the Choledochal Cyst—Revisiting the Todani Classification: Case Report and Review of the Literature

Non-cirrhotic portal hypertension secondary to cholangiointestinal anastomotic stricture after choledochal cyst excision: a case report

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