Curative Hepatectomy for Todani Type IV-A Biliary Dilatation(BD) in Adults: Removal of Cystic Dilatation and Biliary Stricture

Abstract

Introduction: There is no universal surgical strategy for patients with Todani type IV-A BD. Traditionally, excision of the extrahepatic cyst with hepaticojejunostomy is the standard procedure, but long-term outcome is not satisfactory. This study aimed to analyze postoperative and long-term outcomes of a consecutive series of patients undergoing curative hepatectomy for Todani type IV-A BD. Patients and method: All patients who underwent hepatectomy for Todani type IV-A BD in adults during 2007 to 2017 were retrospective analyzed at high-volume centers. Patients were divided into two groups, A: re-operation group who had previous surgery, B: operation group who received initial surgical treatment. Two principles were used in this study. One is radical but conservative hepatectomy and the other type of surgery was based on the anatomical level of diseased bile duct. Segmental BD was removed by anatomical hepatectomy. Results: There were 117 patients enrolled, 66 in group A and 51 in group B. Hepatectomy was performed in 63 and 43 patients in group A and B, respectively. Local BD excision in hepatic hilum was performed in 3 and 8 patients (P = 0.084), while radical resection of cystic dilatation of intrahepatic bile ducts was achieved in 60 and 48 patients, respectively. Postoperative morbidity, but not mortality in group A, was significantly higher. Conclusion: Based on the morphological feature and anatomical level of intrahepatic BD, the strategy of radical but conservative hepatectomy is safe and effective for the treatment of complex Todani type IV-A BD in adults.