SURGICAL-MANAGEMENT OF CHOLEDOCHAL CYSTS

Choledochal cysts are an unusual cause of biliary obstruction with up to 85% of reported cases being of the type I variety, that is, fusifor m dilations of the common bile duct. Recommended management of this ty pe I cyst is complete surgical excision; however, difficulties arise i n type IVa cysts when the cystic dilation extends up into the intrahep atic biliary tree. The purpose of this study is to review the manageme nt of choledochal cysts with particular reference to the type IVa vari ety. Statistical analysis of outcome differences was undertaken using Fisher's exact test. A total of 23 consecutive patients with choledoch al cysts seen at our institution in a 5-year period were reviewed: 8 p atients had type I cysts, 1 patient had a type III cyst, and 14 patien ts had type IVa cysts. Ah type I cysts underwent complete cyst excisio n with hepatico-jejunostomy and modified Hutson loop formation. Of 14 patients with type IVa cysts, 13 underwent complete excision of the ex trahepatic portion of the cyst with hepatico- and cystojejunostomy and modified Hutson loop formation. One patient required hepatic lobectom y. With a mean follow-up of 33 months, 4 patients with type IVa choled ochal cysts have had episodes of recurrent cholangitis, with access to the biliary tree being achieved via the Hutson loop in 3 of the 4 pat ients. Three of these cases represented anastomotic strictures that we re treated nonoperatively. We concluded that recurrent cholangitis and anastomotic stricture after resection of type IVa choledochal cysts i s frequent and recommend Hutson loop formation at the time of primary resection.