CURRENT MANAGEMENT OF BILIARY CYSTS .1. E XTRAHEPATIC CYSTS

A total of 23 patients with, extrahepatic biliary cysts (11 type I, 4 type II, 4 type III and 4 type IVa according to the classification by Todani) seen at our institution in a 15-year period were reviewed with emphasis on management and long-term results at follow-up of 3 weeks- 12 years. Associated hepatobiliary disease occurred in 4 patients, inc luding one case with malignant degeneration in the cyst 23 years after cystenterostomy, and an association of a gallbladder carcinoma with a choledochocele in the other patient. Radical excision of the dilated bile duct and reconstruction by Roux-en-Y hepatico-jejunostomy was per formed in 13 cases (9 type I, 3 type II and 1 type III), combined in 3 cases with an antireflux valve. All 13 operated on patients remained in good health for 6 months to 12 years. These results confirm the nee d for complete early excision of type I, (II) and IVa cysts at all age s before severe complications can occur. Endoscopic treatment of type III choledochocele should be limited to the management of smaller lesi ons.