Reoperative surgery for congenital choledochal cyst

Objective To study the causes of and management for reoperative surgery in patients of congenital choledochal cyst. Methods The clinical data of 41 patients of congenital choledochal cysts undergoing reoperative surgeries were reviewed. Results There were 32 cases of type Ⅰ , 1 of type Ⅱ ,3 of type Ⅳ, and 5 of type Ⅴ according to Todani classification of congenital choledochal cyst. Thirty patients experienced one previous biliary tract surgery, 8 had a history of 2 surgeries and 3 experienced three times of operations previously. Among the 41 patients, 40 presented bile duct stones, 33 suffered from biliary infections, 7 had hilar hepatic duct strictures, 6 had strictures of previous hepatoenteric anastomosis, 5 had carcinomas arising in cysts. The reoperative surgeries for the 41 patients consisted of excisions of extre-hepatic bile cyst and hepato-jejunal anastomosis by Roux-Y fashion (combining with hepatoduodenal ligament dissection and regional lymphadenectomy for two patients with cholangiocarcinoma) in 32 cases, hepatectomies combined with excisions of choledochal cyst and hepato-jejunal anastomosis in 8 cases, reconstruction of hepatoenteric anastomosis by excision of stenosis in one. All patients were followed up with mean time of 53. 7 ± 32. 1 months, ranging from 3 months to 10 years. Intermittent biliary infection was experienced in 4 cases during follow-up period, and there was no anastomotic stricture and stone recurrence. Conclusion The main causes of reoperation for congenital choledochal cyst patients with a history of previous surgery are complications arising from incorrect surgical procedure and misdiagnosis. Complete excision of extra hepatic bile cyst combined with Roux-en-Y hepatojejunal anastomosis benefits patients who had a failed previous surgery. Key words: Choledochal cyst; Reoperation; Postoperative complications