Planned hepatectomy for the"central type"intrahepatic and extrahepatic choledochal cysts

Abstract

Objective To retrospectively study the clinical value and the advantages inplanned hepatectomyfor thecentral typeintrahepatic and extrahepatic choledochal cysts. Methods The clinical data of 7 patients with thecentral typeof intrahepatic and extrahepatic choledochal cysts which were treated withplanned hepatectomyfrom January 2014 through April 2017 at the Department of Biliary Tract Surgery of the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University were retrospectively analyzed. Results All the patients completed radical resection of the intrahepatic and extrahepatic choledochal cysts in accordance with theplanned hepatectomy. The operations included 6 patients who were treated with percutaneous transhepatic cholangial drainage (PTCD) and 5 patients with portal vein embolization (PVE) prior to the surgical excision. Combined right liver resection was performed in 6 patients, and combined left liver resection in one patient. All the 7 patients had a history of chronic cholangitis. Liver volume tests demonstrated that the hemiliver volume to be removed (the embolized hemiliver) significantly decreased after PVE, whereas the hemilivers to be persevered were remarkably enlarged. No complication associated with PTCD and PVE occurred. The mean postoperative hospitalization was 12 days. Liver function tests suggested all the patients recovered well. No postoperative complication of bleeding, infection or liver function failure was observed, except in one patient who experienced pleural and abdominal effusion. Conclusions Combined subtotal hepatectomy may increase the risk of complications associated with thecentral typeintrahepatic and extrahepatic choledochal cysts. The surgical strategy in planned hepatectomy can be used effectively to treat thecentral typeof intrahepatic and extrahepatic choledochal cysts, with improved surgical safety, decrease in incidences of postoperative liver function failure and residual choledochal cysts. Key words: Intrahepatic and extrahepatic bile duct cysts; Congenital cystic dilatation of bile duct; Planned hepatectomy; Percutaneous transhepatic cholangial drainage (PTCD); Portal vein embolization (PVE)