Late complications after excisional operation in patients with choledochal cyst.

BACKGROUND: The follow-up results of 28 patients with choledochal cysts, 16 type I (solitary extrahepatic cyst) and 12 type IVA (extra and intrahepatic cysts), after excision of extrahepatic dilated bile duct were analyzed to evaluate detailed late complications.

STUDY DESIGN: Hepaticojejunostomy with a wide opening (10 to 30 mm) was created using hepaticoplasty, if necessary, in a Roux-en-Y manner. The mean follow-up period after excisional procedure was 8 +/- 5 (standard error of the mean) years, ranging from one to 18 years.

RESULTS: All patients were alive and carcinoma was not observed. Three patients (two with type I and one with type IVA cysts) had intrahepatic calculi. However, they had no evidence of anastomotic stricture on direct cholangiogram, although all bile cultures infected, mainly with Klebsiella and Escherichia coli. Intrahepatic gallstones were successfully treated with percutaneous transhepatic cholangioscopy and reoperation was not required. Thus, intrahepatic calculi associated with cholangitis, but not with anastomotic stricture, were found in 10.7 percent of the patients after excision of choledochal cyst.

CONCLUSIONS: Long-term follow-up evaluation is necessary, with special attention being given to intrahepatic calculi, even in the absence of an anastomotic stricture.