ABSTRACT
Objective To evaluate the long-term effect of surgical procedures for congenital choledochal cyst (CCC).Methods From 1986 to 2000, 120 cases of CCC were admitted and 73 of them underwent the primary operations in General Hospital of PLA. Three types procedures were performed,type I: external drainage of CCC in 7 cases; type II:cystojejunal Roux-en-Y anastomosis in 5 cases; type III: cyst excision with cystojejunal Roux-en-Y anastomosis or cystoduodenostomy in 57cases,and other procedures in 4 cases.Results 68 cases were followed-up for 6 months to 5 years (median 2.7 years). Three cases undergoing type I operations accepted reoperations;two cases undergoing type II operations accepted reoperations due to severe complications as cholongitis and hepatolithiasis; 57 cases treated by type III operation with the good results 88.7% and none reoperation.Conclusions External drainage is only a first-aid management on emergency basis. Internal drainage should never be done,because the effect is temporary,and severe complications result in reoperations. Cyst excision with biliary tract reconstruction is recommended as the optimal treatment of CCC.
ABSTRACT
Objective To evaluate the therapeutic effect of different types of biliary tract reconstruction on the post- resection of congenital choledochal cyst (CCC). Methods 106 cases of CCC undergoing resection of CCC with Roux-en-Y hepaticojejunostomy as biliary tract reconstruction were followed up and analysed. Results In this series, three kinds of biliary tract reconstruction were performed, including single Roux-en-Y hepaticojejunostomy in 48 cases, intussusceptive valve and rectangular valve lying on the jejunal segmental of Roux-en-Y hepaticojejunostomy in 37 and 21 cases, respectively. 61 cases were followed up for 4.82 years in average. None of them occurred anastomasis stricture. There were 4 cases with ascending cholangitis after primary operation: of them 3 after single Roux-en-Y hepaticojejunostomy; symptoms of 2 out of the 3 cases disappeared after reoperation to set up an intussusceptive valve plasty on the jejunal segmental of Roux-en-Y hepaticojejunostomy; another one was in rectangular valve group. Occasional abdominal pain tooke place in 8 patients, of them, 5 in single Roux-en-Y hepaticojejunostomy group, 2 and 1 in intussusceptive valve and rectangular valve groups, respectively. No patients suffered from ascending cholangitis in the intussusceptive valve plasty group. Conclusions The postoperative ascending cholangitis and anastomasis stricture can be prevented effectively, if a prophylactic intussusceptive valve on the jejunal segmental of Roux-en-Y hepaticojejunostomy is carried out after resection of CCC for biliary tract reconstruction. This procedure corresponds to the biliary tract physiology.
