CYSTIC DILATATION OF THE COMMON BILE-DUCT - SURGICAL-TREATMENT AND LONG-TERM RESULTS

Twelve patients (11 female) with an extrahepatic biliary cyst (six typ e I, three type II and three type III according to the classification of Todani) are reviewed with emphasis on aetiology, clinical features and long-term results at follow-up of 3-10 years. The clinical manifes tations were abdominal pain, cholestasis with jaundice, fever and epis odes of pancreatitis. The diagnosis was established before surgery in all cases by ultrasonography, endoscopic retrograde cholangiopancreato graphy, percutaneous transhepatic cholangiography and computed tomogra phy. An abnormally long common channel was found in four patients. Thr ee patients had had cysts drained internally in the 1970s. Of these th ree patients, one developed carcinoma of the cyst 23 years later. Radi cal excision of the dilated bile duct and reconstruction by Roux-en-Y hepaticojejunostomy was performed in nine cases. Two patients, each wi th a small choledochocele, were treated successfully by endoscopic sph incterotomy and stone extraction. There were no serious postoperative complications. All nine patients operated on remained in good health f or 3-10 years. These results support radical excision of the cysticall y dilated bile duct with reconstruction by end-to-side Roux-en-Y hepat icojejunostomy for types I and II cyst. Endoscopic treatment of type m choledochocele should be limited to the management of smaller lesions .