Extrahepatic cyst excision and partial hepatectomy for Todani type IV-A cysts.

Abstract

BACKGROUND:

Extrahepatic cyst excision and Roux-en-Y hepaticojejunostomy is not satisfactory in many patients with complex Todani type IV-A choledochal cysts.

AIMS:

To report the results of combined extrahepatic cyst excision, partial hepatectomy, and Roux-en-Y hepaticojejunostomy for type IV-A choledochal cysts.

METHODS:

The records of patients who received extrahepatic cyst excision, partial hepatectomy, and Roux-en-Y hepaticojejunostomy for type IV-A choledochal cysts from January 2002 to December 2011 were retrospectively reviewed, and surgical outcomes analysed.

RESULTS:

59 patients (30.5% males; mean age, 43.2 ± 18.4 years) were included. Radical excision of cystically dilated bile ducts was achieved in 53 patients (89.8%). Bile leakage, delayed wound healing, and abdominal infection occurred in 5 (8.47%), 7 (11.86%), and 3 (5.08%) patients, respectively. Forty-nine patients (83.1%) were followed for an average of 42.6 ± 15.3 months. During the follow-up, 6 patients (12.2%) experienced recurrent cholangitis. Long-term biliary function was excellent in 33 (67.4%), good in 9 (18.4%), fair in 5 (10.2%), and poor in 2 (4.1%) patients.

CONCLUSION:

Combined extra-hepatic cyst excision, partial hepatectomy, and Roux-en-Y hepaticojejunostomy is effective for the treatment of complex Todani type IV-A choledochal cysts with substantial intrahepatic bile duct involvement and hilar bile duct stenosis.

• Authors: Hong-Tian Xia, Jia-Hong Dong, Tao Yang, Jian-Ping Zeng, Bin Liang
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 46 Issue 11 Pg. 1025-30 (Nov 2014) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 25190435 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2014. Published by Elsevier Ltd.

Topics

• Adult
• Aged
• Anastomosis, Roux-en-Y (methods)
• Cholangiopancreatography, Endoscopic Retrograde (methods)
• Choledochal Cyst (diagnostic imaging, surgery)
• Cohort Studies
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Hepatectomy (methods)
• Humans
• Jejunum (surgery)
• Length of Stay
• Liver (surgery)
• Male
• Middle Aged
• Operative Time
• Pain, Postoperative (physiopathology)
• Preoperative Care (methods)
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Time Factors
• Treatment Outcome
• Young Adult