Diagnosis and treatment of congenital choledochal cyst: 20 years' experience in China

AIM To summarize the experience of diagnosis and treatment of congenital ch oledochal cyst in the past 20 years (1980 - 2000). METHODS The clinical data of 108 patients admitted from 1980 to 2000 were a nalyzed retrospectively. RESULTS Abdominal pain, jaundice and abdominal mass were presented in most child cases. Clinical symptoms in adult cases were non-specific, resulting in delayed diagnosis frequently. Fifty-seven patients (52.7%) had coexisten t pancreatiobiliary disease. Carcinoma of the biliary duct occurred in 18 p atients (16.6%). Ultrasonic examination was undertaken in 94 cases, ERCP pe rformed in 46 cases and CT in 71 cases. All of the cases were correctly dia gnosed before operation. Abnormal pancreatobiliary duct junction was found in 39 patients. Before 1985 the diagnosis and classification of congenital choledochal cyst were established by ultrasonography preoperatively and con firmed during operation, the main procedures were internal drainage by cyst enterostomy. After 1985, the diagnosis was established by ERCP and CT, and cystectomy with Roux-en-Y hepaticojejunostomy was the conventional procedu res. In 1994, we reported a new and simplified operative procedure in order to reduce the risk of choledochal cyst malignancy. Postoperative complicat ion was mainly retrograde infection of biliary tract, which could be contro lled by the administration of antibiotics, there was no perioperative morta lity. CONCLUSION The concept in diagnosis and treatment of congenital choledochal cyst has obviously been changed greatly. CT and ERCP were of great help in the classification of the disease. Currently, cystectomy with Roux-en-Y he paticojejunostomy is strongly recommended as the choice for patients with t ype I and type IV cysts. Piggyback orthotopic liver transplantation is indi cated in type V cysts (Caroli's disease) with frequently recurrent cholangi tis.