Operative management of intrahepatic biles ducts and pancreaticobiliary common duct in choledochal cyst

Objective Postoperative complications such as cholangitis and calculi may develop even after the complete excision of a choledochal cyst. Since congenital stenosis of the intrahepatic bile ducts are more likely to be the cause of postoperative complications, operative procedures for intrahepatic stenosis and pancreatic calculi in pancreaticobiliary common duct are reported. Methods The operative outcome of two groups were studied. Group Ⅰ (n= 13): simple hepaticojejunostomy with complete excision of a choledochal cyst was performed. Group Ⅱ (n = 24 ) in addition to the operative procedures of group one, surgery for stenosis of intrahepatic bile ducts was performed and all of the pancreaticobiliary common ducts were lavaged with normal saline.Results In group one, there were six cases of intrahepatic dilatation, four of them showing cystic type. In group two, 11 had intrahepatic dilatation, 5 of them showing cystic. Stenosis that involved an intraluminal membrane or septum were seen in the cases with intrahepatic cystic dilatation and the stenosis were excised from the divided end of the common hepatic duct at the hepatic hilum. The pancreatic calculi were found in the pancreaticobiliary common duct in some cases. According to the long-term follow-up, the incidence of postoperative complications in group two was much less than that in group one.Conclusions On the base of hepaticojejunostomy with radical excision of a choledochal cyst, operative management of intrahepatic stenosis and pancreaticobiliary common duct calculi can reduce the postoperative complications significantly.