Surgical treatment of choledochal cyst: Retrospective review of the operated cases over the past 5 years in Pediatric surgery department of Ain Shams University

Abstract

Choledochal cysts are congenital bile duct anomalies that can involve the extra or intrahepatic biliary radicals. It may present by jaundice, colicky pain, or palpable right upper quadrant abdominal mass. The aim of the present study was to assess the outcomes of different methods of biliary drainage after excision of the cyst and the most common complications arising. That study involved the last 5 years from May 2010 to May 2015, in the pediatric surgery department of Ain Shams university. The cases were chosen according to some inclusion criteria. Cases with associated anomalies were excluded. Assessment of surgical techniques, complications, general condition and liver functions tests of patients were done. Twenty cases were chosen for this study, within pediatric age group. The results showed a peak of the anomaly between 5 & 6 years. Female to male ratio was almost the double. Jaundice was the commonest complaint in 65% of cases followed by abdominal pain in 35% and a triad of jaundice, pain and swelling in the right upper quadrant of the body in 15% of cases. Two cases were totally asymptomatic and accidentally discovered. Abdominal ultrasonography was the chief method of diagnosis & follow up of the choledochal cyst, beside CT and MRCP. Complete excision of the cyst was done to all patients except 1 case subjected to partial excision due to adhesions. The operation was followed by hepatoduodenostomy or hepatojejunostomy. Complications occurred in five cases. Four cases suffered from wound infections. Only one case suffered from ascending cholangitis, and was managed medically. The results were discussed and confronted with those of previous investigators. Recommendations were suggested for further researches, aiming at better results in treatment and avoidance of complications by early diagnosis and long follow up of the patients.

Conclusion : Although uncommon, yet biliary cystic disease remains an interesting surgical problem. Avoidance of complications associated with choledochal cysts requires early diagnosis by ultrasonography and definite surgical management, mostly as complete excision and hepaticoenterostomy. Laparoscopic anastomosis with the duodenum is an easy, less time consuming and promising procedure. Further researches are needed to enhance success of treatment, to avoid complications and decrease morbidity and mortality rates. Long-term follow-up is necessary to detect any late complications, especially the development of malignancy.