Adult Choledochal Cysts: Surgical Management and Complications

Abstract

The surgical management of 7 adult female patients with choledochal cysts, from December 1985 to December 1993, is presented. Upper abdominal pain was present in all cases, jaundice in 3 patients, and a palpable right upper quadrant mass in 1. The diagnosis was confirmed by ultrasonography, per-operative cholangiography, tube cholecystocholangiography, computed tomography, endoscopic retrograde cholangiography, and percutaneous transhepatic cholangiography – performed singly or in combination. An abnormal pancreaticobiliary junction was documented in 2 patients: on tube cholangiography in 1 and on endoscopic retrograde cholangiography in the other. The cysts in these patients were classified as follows: 2 type I, 1 type II, 3 type IVa, and 1 type V (Caroli’s disease). Internal drainage was performed in 2 patients, and both developed complications. Four patients underwent cyst excision with one anastomotic leak. Malignant and severe dysplastic changes were seen in 3 patients: 2 type IVa cysts and 1 type V cyst. We believe that cyst excision is essential to separate the pancreatic and biliary systems with Roux-en-Y hepaticojejunostomy to prevent long-term complications.