Highlights
- •Choledochal cyst (CDC) is a congenital malformation of the biliary tree.
- •Outcomes of re-operation for delayed biliary complications after CDC excision has never been studied before.
- •Surgery offers excellent results for majority of the patients with delayed biliary complications after CDC excision.
- •The incidence of type IV cysts is significantly more in delayed biliary complication patients.
Abstract
Purpose
The purpose of this study is to review our experience in patients who underwent re-operation
for delayed biliary complications after choledochal cyst (CDC) excision.
Methods
All the patients who underwent re-operation. for delayed biliary complications after
CDC excision between August 2007 and July 2020 were included in this retrospective
study. The outcomes of these patients were compared with those who underwent primary
surgery (CDC excision) at our institution.
Results
Of the total 40 patients with delayed biliary complications, 25 (62.5%) were female.
Thirty-seven (92.5%) patients had a history of cholangitis. The median interval between
CDC excision and the reoperation was 70 (4–216) months. The median duration of symptoms
before reoperation was 12 (2.5–84) months. Re-do hepaticojejunostomy and direct hepaticojejunostomy
were performed in 34 and in 6 patients respectively. Median operative time and blood
losses were 219 min and 150 ml respectively. The median postoperative stay was 9 days.
Postoperative complications developed in 10 (25%) patients. There was no operative
mortality. Over a median follow-up of 71 months, a satisfactory outcome was achieved
in 86% of patients. Restricture and intrahepatic stones developed in three and two
patients respectively. Incidence of type IV cyst, cholangitis before operation, and
operative blood loss were significantly more in the re-operative group. Clinical outcomes
like the incidence of recurrent cholangitis, re-stricture, and postoperative hospital
stay were comparable between the two groups.
Conclusion
Surgery affords excellent results for majority of the patients with delayed biliary
complications after CDC excision. Type IV cysts are more commonly associated with
the development of delayed biliary complications.
Keywords
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Article info
Publication history
Published online: February 06, 2023
Accepted:
February 4,
2023
Received in revised form:
January 18,
2023
Received:
November 20,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
