Surgical management of choledochal cysts in adults; Our experience

Abstract

Choledochal cysts are the name given to the congenital cystic dilatation of the intrahepatic and/or extrahepatic bile ducts. It is most commonly observed in childhood ages but there are cases diagnosed in adulthood. They are precancerous lesions and should be resected when diagnosed. The aim of this study is to present the results of the patients who underwent surgical therapy due to choledochal cyst. This study retrospectively included adult patients who were diagnosed with choledochal cyst between January 2015 and December 2019. In addition to demographic data such as age and gender, the operative and postoperative morbidity and mortality rates were documented. The study included nine patients who underwent surgery due to a choledochal cyst. Of nine patients, three (33%) were male and six (66%) were female. The general mean age of the patients was 42.4 while the mean age of male patients was 56.5 and female patients was 35.5. The complaints were jaundice in three patients (33%), acute pancreatitis in two patients (22%), biliary colic abdominal pain in two patients (22%), sepsis in one patient (11%), and suspected malignity in one patient (11%). Type 1 choledochal cyst was detected in all cases. In all patients included in the study, the external bile ducts including the intrapancreatic part were resected by incising the choledochal dilatation from the endpoint. The surgical procedure was performed laparoscopically in two cases (22%). A biliary fistula that regressed with medical treatment was detected in postoperative one patient (11%). A postoperative pancreas fistula was not detected in any patient. Margin positive adenocarcinoma was observed in the choledochal incisions of one patient who underwent laparoscopic surgery. The patient was taken to re-exploration and conventional pancreaticoduodenectomy was performed. Choledochal cysts detected in older ages and male patients have a greater risk of malignity. Therefore, complete resection of bile ducts is necessary. The intraoperative frozen examination should be kept in mind as it protects patients from the second operation.

Keywords

• Choledochal cyst
• hepaticojejunostomy
• cholangiocarcinoma
• jaundice