T. Miyano et al., HEPATICOENTEROSTOMY AFTER EXCISION OF CHOLEDOCHAL CYST IN CHILDREN - A 30-YEAR EXPERIENCE WITH 180 CASES, Journal of pediatric surgery, 31(10), 1996, pp. 1417-1421
In the long-term follow-up of patients with choledochal cyst, postoper
ative ascending cholangitis and/or stone formation in the intrahepatic
bile ducts (IHBD) owing to anastomotic stricture present serious prob
lems. To prevent the formation of anastomotic strictures, some surgeon
s recently have performed hepaticoenterostomy at the hepatic hilum, wi
th a wide stoma, in ail patients with choledochal cyst. The authors of
the present study review the surgical procedures performed on a total
of 180 children with choledochal cyst and discuss the treatment of ch
oice, with special reference to the types of hepaticoenterostomy. The
medical records and radiographs of all patients treated for choledocha
l cyst between January 1964 and December 1993 at the authors' institut
ions were reviewed. A total of 180 patients (mean age at time of surge
ry, 4.3 years) had follow-up for a mean of 11.1 years; 174 of them had
cyst excision and hepaticoenterostomy, and six had cystoenterostomy.
Of the 174 patients who underwent cyst excision, 171 had a conventiona
l hepaticoenterostomy; two had an intrahepatic cystoenterostomy, and o
ne had a hepaticoenterostomy at the hepatic hilum. IHBD stones with or
without cholangitis developed postoperatively in four (2.3%) of the 1
71 patients who had conventional hepaticoenterostomy. The age at time
hepaticoenterostomy of these four patients was 12, 7, 16, and 6 years.
Postoperative IHBD stone formation and cholangitis were not found in
121 patients under 5 years of age. The authors recommend conventional
hepaticoenterostomy as the treatment of choice for children with chole
dochal cyst. Hepatico-enterostomy at the hepatic hilum is indicated in
only selected cases. Copyright (C) 1996 by W.B. Saunders Company