COEXISTING BILIARY ANOMALIES AND ANATOMICAL VARIANTS IN CHOLEDOCHAL CYST

Background Excision is the treatment of choice for choledochal cyst, a nd free bile drainage is essential to avoid ascending cholangitis. How ever, anastomosis between the relatively narrow common hepatic duct an d bowel (conventional anastomosis) in case of type IV-A cyst, co-exist ing biliary anomalies and anatomical variations may cause ascending ch olangitis resulting from insufficient biliary decompression. Methods O ne hundred and four patients with choledochal cyst were treated by cys t excision. Conventional anastomosis was performed in 22 patients and hilar anastomosis in 82. Results An anastomotic stricture developed in nine of the 22 conventional anastomosis cases and all required reoper ation. Of the 82 hilar anastomosis cases, only one required reoperatio n for a primary stricture. Go-existing biliary anomalies and anatomica l variants were seen in 26 patients: (1) primary stricture in 18; (2) aberrant posterior duct in two; (3) low confluence of the hepatic duct s in two; (4) aberrant hepatic artery in two; and (5) very small bile duct in two. All 26 patients underwent widening of the ductal lumen (d uctoplasty) or additional procedures. Conclusion Complete removal of t he extrahepatic bile duct and a wide hilar anastomosis is essential to prevent ascending cholangitis. Ductoplasty or additional procedure ca n be performed only at the hilum.