Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1998 Aug;228(2):159–166. doi: 10.1097/00000658-199808000-00003

Bile duct cysts in adults: a multi-institutional retrospective study. French Associations for Surgical Research.

J P Lenriot 1, J F Gigot 1, P Ségol 1, P L Fagniez 1, A Fingerhut 1, M Adloff 1
PMCID: PMC1191455  PMID: 9712559

Abstract

OBJECTIVE: To review the features of adult patients undergoing surgery for bile duct cysts, focusing on the anatomy of the biliary tree as well as the long-term outcome. SUMMARY BACKGROUND DATA: Bile duct cysts (BDCs) are uncommon in Western countries, and the majority of reported cases originate from Asia. Japanese authors have emphasized the frequent association of extra- and intrahepatic bile duct dilatations, but grading of patients based on Todani's classification is often hindered by the absence of an accurate definition of types IC and IVA cysts. Moreover, despite the increasing use of extrahepatic cyst excision, little is known about the long-term outcome in patients with intrahepatic bile duct involvement. METHODS: Forty-two adult patients with BDC were treated between 1980 and 1992 in 17 institutions of the French Associations for Surgical Research. Clinical presentation, radiologic presurgical evaluation, and surgical procedures were analyzed. The long-term postsurgical outcome was derived from patient charts, attending physicians, or direct patient contact. RESULTS: Twelve patients (30%) had recurrent abdominal pain or jaundice from childhood. Seven (17%) had undergone prior cystenterostomy. Twenty-one (50%) had a Todani-type IVA cyst with extra- and intrahepatic bile duct involvement. Of these, nine had segmental, exclusively left-sided intrahepatic bile duct dilatation. Biliary carcinoma was encountered in five patients (12%). Extrahepatic cyst excision with a Roux-en-Y hepaticojejunostomy was performed in 34 patients with type I or IV cysts. The overall operative mortality rate was 2.4%. Long-term results were clearly correlated with cyst type: during a mean follow-up of 8.4 years, 11 of 12 patients (92%) treated by cyst excision for type I cyst remained free of symptoms, whereas 31% of patients who underwent surgery for type IV cyst had episodic or severe cholangitis with intrahepatic stones. CONCLUSIONS: In patients with BDC, particular attention must be given to the associated intrahepatic bile duct dilatations. We propose a modification of Todani's classification to distinguish cystic, segmental, and fusiform dilatations of the intrahepatic biliary tree in type IV cysts. In patients with segmental left intrahepatic cystic dilatations, combined left liver lobectomy and extrahepatic cyst excision is suggested to decrease late postsurgical biliary complications.

Full text

PDF
159

Images in this article

160Figure 1.
on p.160
164Figure 3.
on p.164

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Babbitt D. P. [Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb]. Ann Radiol (Paris) 1969;12(3):231–240. [PubMed] [Google Scholar]
  2. Bloustein P. A. Association of carcinoma with congenital cystic conditions of the liver and bile ducts. Am J Gastroenterol. 1977 Jan;67(1):40–46. [PubMed] [Google Scholar]
  3. Chijiiwa K. Hazard and outcome of retreated choledochal cyst patients. Int Surg. 1993 Jul-Sep;78(3):204–207. [PubMed] [Google Scholar]
  4. Chijiiwa K., Koga A. Surgical management and long-term follow-up of patients with choledochal cysts. Am J Surg. 1993 Feb;165(2):238–242. doi: 10.1016/s0002-9610(05)80518-5. [DOI] [PubMed] [Google Scholar]
  5. Chijiiwa K., Komura M., Kameoka N. Postoperative follow-up of patients with type IVA choledochal cysts after excision of extrahepatic cyst. J Am Coll Surg. 1994 Dec;179(6):641–645. [PubMed] [Google Scholar]
  6. Deziel D. J., Rossi R. L., Munson J. L., Braasch J. W., Silverman M. L. Management of bile duct cysts in adults. Arch Surg. 1986 Apr;121(4):410–415. doi: 10.1001/archsurg.1986.01400040046006. [DOI] [PubMed] [Google Scholar]
  7. Flanigan D. P. Biliary carcinoma associated with biliary cysts. Cancer. 1977 Aug;40(2):880–883. doi: 10.1002/1097-0142(197708)40:2<880::aid-cncr2820400242>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  8. Flanigan P. D. Biliary cysts. Ann Surg. 1975 Nov;182(5):635–643. doi: 10.1097/00000658-197511000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hata Y., Sasaki F., Takahashi H., Tamura M., Ohkawa Y., Saji Y., Kurauchi N., Manabe K., Uchino J. Surgical treatment of congenital biliary dilatation associated with pancreaticobiliary maljunction. Surg Gynecol Obstet. 1993 Jun;176(6):581–587. [PubMed] [Google Scholar]
  10. Hepp J., Mutricy J. Réflexions sur le traitement de la dilatation kystique congénitale de la voie biliaire principale. Lyon Chir. 1971 May-Jun;67(3):173–175. [PubMed] [Google Scholar]
  11. Hewitt P. M., Krige J. E., Bornman P. C., Terblanche J. Choledochal cysts in adults. Br J Surg. 1995 Mar;82(3):382–385. doi: 10.1002/bjs.1800820333. [DOI] [PubMed] [Google Scholar]
  12. Howell C. G., Templeton J. M., Weiner S., Glassman M., Betts J. M., Witzleben C. L. Antenatal diagnosis and early surgery for choledochal cyst. J Pediatr Surg. 1983 Aug;18(4):387–393. doi: 10.1016/s0022-3468(83)80187-0. [DOI] [PubMed] [Google Scholar]
  13. Iwai N., Yanagihara J., Tokiwa K., Shimotake T., Nakamura K. Congenital choledochal dilatation with emphasis on pathophysiology of the biliary tract. Ann Surg. 1992 Jan;215(1):27–30. doi: 10.1097/00000658-199201000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Jona J. Z., Babbitt D. P., Starshak R. J., LaPorta A. J., Glicklich M., Cohen R. D. Anatomic observations and etiologic and surgical considerations in choledochal cyst. J Pediatr Surg. 1979 Jun;14(3):315–320. doi: 10.1016/s0022-3468(79)80490-x. [DOI] [PubMed] [Google Scholar]
  15. Joseph V. T. Surgical techniques and long-term results in the treatment of choledochal cyst. J Pediatr Surg. 1990 Jul;25(7):782–787. doi: 10.1016/s0022-3468(05)80019-3. [DOI] [PubMed] [Google Scholar]
  16. Kasai M., Asakura Y., Taira Y. Surgical treatment of choledochal cyst. Ann Surg. 1970 Nov;172(5):844–851. doi: 10.1097/00000658-197011000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kimura K., Ohto M., Ono T., Tsuchiya Y., Saisho H., Kawamura K., Yogi Y., Karasawa E., Okuda K. Congenital cystic dilatation of the common bile duct: relationship to anomalous pancreaticobiliary ductal union. AJR Am J Roentgenol. 1977 Apr;128(4):571–577. doi: 10.2214/ajr.128.4.571. [DOI] [PubMed] [Google Scholar]
  18. Lilly J. R., Stellin G. P., Karrer F. M. Forme fruste choledochal cyst. J Pediatr Surg. 1985 Aug;20(4):449–451. doi: 10.1016/s0022-3468(85)80239-6. [DOI] [PubMed] [Google Scholar]
  19. Lilly J. R. Total excision of choledochal cyst. Surg Gynecol Obstet. 1978 Feb;146(2):254–256. [PubMed] [Google Scholar]
  20. Lipsett P. A., Pitt H. A., Colombani P. M., Boitnott J. K., Cameron J. L. Choledochal cyst disease. A changing pattern of presentation. Ann Surg. 1994 Nov;220(5):644–652. doi: 10.1097/00000658-199411000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Martin E., Corcos V., Albano O. La dilatation congénitale des voies biliaries intrahépatiques segmentaires (maladie de J. Caroli). Etude anatomique d'un nouveau cas. Presse Med. 1965 Oct 27;73(45):2565–2570. [PubMed] [Google Scholar]
  22. Myburgh J. A. The Hepp-Couinaud approach to strictures of the bile ducts. I. Injuries, choledochal cysts, and pancreatitis. Ann Surg. 1993 Nov;218(5):615–620. doi: 10.1097/00000658-199321850-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Nagorney D. M., McIlrath D. C., Adson M. A. Choledochal cysts in adults: clinical management. Surgery. 1984 Oct;96(4):656–663. [PubMed] [Google Scholar]
  24. O'Neill J. A., Jr, Templeton J. M., Jr, Schnaufer L., Bishop H. C., Ziegler M. M., Ross A. J., 3rd Recent experience with choledochal cyst. Ann Surg. 1987 May;205(5):533–540. doi: 10.1097/00000658-198705000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Ohi R., Koike N., Matsumoto Y., Ohkohchi N., Kasai M. Changes of intrahepatic bile duct dilatation after surgery for congenital dilatation of the bile duct. J Pediatr Surg. 1985 Apr;20(2):138–142. doi: 10.1016/s0022-3468(85)80286-4. [DOI] [PubMed] [Google Scholar]
  26. Olbourne N. A. Choledochal cysts. A review of the cystic anomalies of the biliary tree. Ann R Coll Surg Engl. 1975 Jan;56(1):26–32. [PMC free article] [PubMed] [Google Scholar]
  27. Ono J., Sakoda K., Akita H. Surgical aspect ot cystic dilatation of the bile duct. An anomalous junction of the pancreaticobiliary tract in adults. Ann Surg. 1982 Feb;195(2):203–208. doi: 10.1097/00000658-198202000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Robertson J. F., Raine P. A. Choledochal cyst: a 33-year review. Br J Surg. 1988 Aug;75(8):799–801. doi: 10.1002/bjs.1800750826. [DOI] [PubMed] [Google Scholar]
  29. SAKO K., SEITZINGER G. L., GARSIDE E. Carcinoma of the extrahepatic bile ducts; review of the literature and report of six cases. Surgery. 1957 Mar;41(3):416–437. [PubMed] [Google Scholar]
  30. Spitz L. Choledochal cyst. Surg Gynecol Obstet. 1978 Sep;147(3):444–452. [PubMed] [Google Scholar]
  31. Stain S. C., Guthrie C. R., Yellin A. E., Donovan A. J. Choledochal cyst in the adult. Ann Surg. 1995 Aug;222(2):128–133. doi: 10.1097/00000658-199508000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Tan K. C., Howard E. R. Choledochal cyst: a 14-year surgical experience with 36 patients. Br J Surg. 1988 Sep;75(9):892–895. doi: 10.1002/bjs.1800750921. [DOI] [PubMed] [Google Scholar]
  33. Todani T., Narusue M., Watanabe Y., Tabuchi K., Okajima K. Management of congenital choledochal cyst with intrahepatic involvement. Ann Surg. 1978 Mar;187(3):272–280. doi: 10.1097/00000658-197803000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Todani T., Watanabe Y., Fujii T., Toki A., Uemura S., Koike Y. Congenital choledochal cyst with intrahepatic involvement. Arch Surg. 1984 Sep;119(9):1038–1043. doi: 10.1001/archsurg.1984.01390210042010. [DOI] [PubMed] [Google Scholar]
  35. Todani T., Watanabe Y., Narusue M., Tabuchi K., Okajima K. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg. 1977 Aug;134(2):263–269. doi: 10.1016/0002-9610(77)90359-2. [DOI] [PubMed] [Google Scholar]
  36. Todani T., Watanabe Y., Toki A., Urushihara N. Carcinoma related to choledochal cysts with internal drainage operations. Surg Gynecol Obstet. 1987 Jan;164(1):61–64. [PubMed] [Google Scholar]
  37. Todani T., Watanabe Y., Toki A., Urushihara N., Sato Y. Reoperation for congenital choledochal cyst. Ann Surg. 1988 Feb;207(2):142–147. doi: 10.1097/00000658-198802000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Tsuchida Y., Ishida M. Dilatation of the intrahepatic bile ducts in congenital cystic dilatation of the common bile duct. Surgery. 1971 May;69(5):776–781. [PubMed] [Google Scholar]
  39. Voyles C. R., Smadja C., Shands W. C., Blumgart L. H. Carcinoma in choledochal cysts. Age-related incidence. Arch Surg. 1983 Aug;118(8):986–988. doi: 10.1001/archsurg.1983.01390080088022. [DOI] [PubMed] [Google Scholar]
  40. Yamaguchi M. Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature. Am J Surg. 1980 Nov;140(5):653–657. doi: 10.1016/0002-9610(80)90051-3. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES