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Gang S, Kwon H, Song IH, Namgoong JM. Clinical implications of pediatric biliary intraepithelial neoplasia diagnosed from a choledochal cyst specimen. World J Surg Oncol 2024; 22:105. [PMID: 38643155 PMCID: PMC11031949 DOI: 10.1186/s12957-024-03384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/06/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Biliary intraepithelial neoplasia (BilIN), a noninvasive precursor of cholangiocarcinoma, can manifest malignant transformation. Since cholangiocarcinoma (CCA) may progress due to chronic inflammation in the bile ducts and gallbladder, choledochal cysts are considered a precursor to CCA. However, BilIN has rarely been reported in children, to date. METHODS We reviewed medical records of patients (< 18 years of age, n = 329) who underwent choledochal cyst excision at Asan Medical Center from 2008 to 2022. BilIN was diagnosed in 15 patients. Subsequent analyses were performed of the demographics, surgical procedures, clinical course, and outcomes in these patients. Subgroup analysis and multivariate logistic regression test were performed to identify factors influencing BilIN occurrence. RESULTS The mean age of the patients included in our study was 40.1 ± 47.6 months. In 15 patients, BilIN of various grades was diagnosed. Todani type I was prevalent in 80% of the patients. The median age at surgery was 17 months. During a mean follow-up of 63.3 ± 94.0 months, no adverse events such as stone formation in the remnant intrapancreatic common bile duct and intrahepatic duct or cholangiocarcinoma were observed, indicating a favorable outcome until now. CONCLUSIONS The potential progression of choledochal cysts to BilIN in children was demonstrated. These results could underscore the importance of early and comprehensive excision of choledochal cysts, including resection margins for associated lesions and more thorough postoperative surveillance in patients with or at risk of BilIN.
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Affiliation(s)
- Sujin Gang
- Department of Pediatric Surgery, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea
| | - Hyunhee Kwon
- Department of Pediatric Surgery, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea
| | - In Hye Song
- Department of Pathology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea.
| | - Jung-Man Namgoong
- Department of Pathology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea.
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Orozco G, Shah MB, Gupta M, Marti F, Mei X, Ancheta A, Desai S, Cavnar M, Evers BM, Zwischenberger J, Gedaly R. Liver transplantation for biliary cysts: perioperative and long-term outcomes. HPB (Oxford) 2023:S1365-182X(23)00130-2. [PMID: 37149484 DOI: 10.1016/j.hpb.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Biliary cysts (BC) is a rare indication for orthotopic liver transplantation (OLT). METHODS We queried the UNOS dataset to identify patients who underwent OLT for Caroli's disease (CD) and choledochal cysts (CC). All patients with BC (CD + CC) were compared to a cohort of patients transplanted for other indications. Patients with CC were also compared to those with CD. Cox proportional hazard model was performed to assess predictors of graft and patient survival. RESULTS 261 patients underwent OLT for BC. Patients with BC had better pre-operative liver function compared to those transplanted for other indications. 5-year graft and patient survival were 72% and 81%, respectively, similar to those transplanted for other indications after matching. Patients with CC were younger and had increased preoperative cholestasis compared to those with CD. Donor age, race, and gender were predictors of poor graft and patient survival in patients transplanted for CC. CONCLUSIONS Patients with BC have similar outcomes to those transplanted for other indications and more frequently require MELD score exception. In patients transplanted for choledochal cysts, female gender, donor age, and African-American race were independent predictors of poor survival. Pediatric patients transplanted for Caroli's disease had better survival compared to adults.
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Affiliation(s)
- Gabriel Orozco
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA
| | - Malay B Shah
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA
| | - Meera Gupta
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA
| | - Francesc Marti
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA
| | - Xiaonan Mei
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA
| | - Alexandre Ancheta
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA
| | - Siddharth Desai
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA
| | - Michael Cavnar
- Markey Cancer Center, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA
| | - B Mark Evers
- Markey Cancer Center, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA
| | - Joseph Zwischenberger
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; Markey Cancer Center, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA
| | - Roberto Gedaly
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; Markey Cancer Center, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA; University of Kentucky Department of Surgery, Lexington, KY, USA.
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3
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Brown ZJ, Baghdadi A, Kamel I, Labiner HE, Hewitt DB, Pawlik TM. Diagnosis and management of choledochal cysts. HPB (Oxford) 2023; 25:14-25. [PMID: 36257874 DOI: 10.1016/j.hpb.2022.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/31/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Choledochal cysts (CCs) are rare cystic dilatations of the intrahepatic and/or extrahepatic bile ducts. We review the pathophysiology, diagnosis, and management of CCs. METHODS MEDLINE/PubMed and Web of Science databases were queried for "choledochal cyst", "bile duct cyst", "choledochocele", and "Caroli disease". Data were synthesized and systematically reviewed. RESULTS Classified according to the Todani Classification, CCs are generally believed to arise secondary to reflux of pancreatic enzymes into the biliary tree due to anomalous pancreaticobiliary duct union. Complications of CCs include abdominal pain, jaundice, cystolithiasis, cholecystitis, pancreatitis, liver abscess, liver cirrhosis and malignant transformation (3-7.5%). Radiological and endoscopic imaging is the cornerstone of CC diagnosis and full delineation of cyst anatomy is imperative for proper management. Management is generally guided by cyst classification with complete cyst excision necessary for CCs with high potential of malignant transformation such as types I and IV. 5-year overall survival after choledochal cyst excision is 95.5%. CONCLUSION Most CCs should undergo surgical intervention to mitigate the risk of cyst related complications such as cholangitis and malignant transformation.
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Affiliation(s)
- Zachary J Brown
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Ihab Kamel
- Department of Radiology, John Hopkins University, Baltimore, MD, USA
| | - Hanna E Labiner
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - D Brock Hewitt
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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4
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Abstract
CONTEXT Choledochal cyst (CHC) is one of the most common causes of surgical jaundice in infants. In 1955, Farello et al. were the first to introduce the laparoscopic approach for treatment of CHC. AIM OF THE STUDY Minimally invasive approaches to the management of CHC excision have been done in pre-schoolers and above but have not yet been described in toddlers, let alone infants. Herein, we review the results of 10 consecutive children <1 year managed with laparoscopic CHC excision and hepaticoduodenostomy. METHODS This retrospective study investigated 10 infants who underwent laparoscopic resection of a CHC with creation of a hepaticoduodenostomy. RESULTS This study was performed on 10 consecutive patients <1 year. Liver fibrosis was found in 4 patients. We had 7 cases with Type 1 CHCs and 3 cases with Type IV A cysts. Total cyst excision was done in all patients, no cases needed blood transfusion and the mean operative time was 200 min. The mean hospital stay was 6 days. Overall, morbidity occurred in 20% of the cases presenting with bouts of cholangitis that resolved without any intervention, once at 6 months, the other at 1-year post-operative. There were neither anastomotic strictures nor biliary fistula formation; magnetic resonance cholangiopancreatography was done to these two cases revealed no stricture and mortality at 30 and 90 days was nil. CONCLUSION Laparoscopic hepaticoduodenostomy in CHC in children <1 year is safe, with satisfactory short-term results.
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Affiliation(s)
- Ahmed Arafa
- Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Moutaz Ragab
- Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Gamal Hassan Eltagy
- Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
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Hinojosa-Gonzalez DE, Roblesgil-Medrano A, Leon SUVD, Espadas-Conde MA, Flores-Villalba E. Biliary reconstruction after choledochal cyst resection: a systematic review and meta-analysis on hepaticojejunostomy vs hepaticoduodenostomy. Pediatr Surg Int 2021; 37:1313-1322. [PMID: 34115175 DOI: 10.1007/s00383-021-04940-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 12/13/2022]
Abstract
Choledochal cysts are a rare pediatric biliary pathology. Excision of the extrahepatic cyst and restoration of biliary-enteric continuity through either hepaticoduodenostomy (HD) or Roux-en-Y hepaticojejunostomy (HJ) is the mainstay treatment. This study aims to determine if either method provides an advantage. Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing hepaticojejunostomy to hepaticoduodenostomy in patients with choledochal cysts. Data were analyzed using Review Manager 5.3. Nine studies were included, operative time was shorter - 97.50 [- 172.31, - 22.69] p = 0.01 and bleeding reduced - 48.98 [- 88.25, - 9.71] p = 0.01 in HD. HD was associated with shorter length of stay 2.18 [- 3.87, - 0.50] p = 0.01 and similar cholangitis and reintervention rates. Time to a normal diet was similar between groups. Biliary reflux was seen more frequently in HD 19.14 [2.60, 140.63] p = 0.004. Complications such as leak and cholangitis were similar between groups. HD represents a viable alternative to HJ with various advantages such as shorter operative time, decreased bleeding and shorter length of hospital stay. Bile reflux remains a major limitation.Level of evidence IV.
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Affiliation(s)
- David Eugenio Hinojosa-Gonzalez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Batallón San Patricio #112, San Pedro Garza García, Monterrey, Nuevo León, Mexico.
| | - Andres Roblesgil-Medrano
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Batallón San Patricio #112, San Pedro Garza García, Monterrey, Nuevo León, Mexico
| | - Sergio Uriel Villegas-De Leon
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Batallón San Patricio #112, San Pedro Garza García, Monterrey, Nuevo León, Mexico
| | - Maria Alejandra Espadas-Conde
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Batallón San Patricio #112, San Pedro Garza García, Monterrey, Nuevo León, Mexico
| | - Eduardo Flores-Villalba
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Batallón San Patricio #112, San Pedro Garza García, Monterrey, Nuevo León, Mexico
- Tecnológico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León, Mexico
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Nuevo León, Mexico
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Lee C, Byun J, Ko D, Yang HB, Youn JK, Kim HY. Comparison of long-term biliary complications between open and laparoscopic choledochal cyst excision in children. Ann Surg Treat Res 2021; 100:186-192. [PMID: 33748032 PMCID: PMC7943283 DOI: 10.4174/astr.2021.100.3.186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/06/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose Cyst excision with hepaticojejunostomy has been the classic procedure for treating choledochal cysts, and the use of laparoscopic treatment has been favored recently. The purpose of this study was to compare the long-term biliary complication of laparoscopic operation with open surgery for choledochal cyst presenting in children. Methods A retrospective study comparing the laparoscopic and open procedures was performed in 185 patients with choledochal cyst in a single children's hospital. There were 109 patients who were operated with open surgery, and 76 patients operated with laparoscopic surgery. The primary outcome was long-term biliary complications and the secondary outcome included operative time, intraoperative transfusion, length of hospital stay, and other late postoperative complications. Results In the patient's demographics, there was no significant difference between the 2 groups. Notably, it was shown that the operative time was longer in the laparoscopic group. The number of patients requiring blood transfusion intraoperatively was lower in the laparoscopic group. It was noted that the hospital stay was not statistically different. The duration to resumption of diet and duration of drainage were longer in the laparoscopic group. Biliary complications were shown to be significantly higher in the open group. The risk factor for long-term biliary complications was noted with the intraoperative transfusion. Conclusion The use of a laparoscopic choledochal cyst excision with hepaticojejunostomy is a safe and feasible technique in a young patient. The long-term biliary complication was lower compared to open surgery, rendering this a good option for pediatric patients.
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Affiliation(s)
- Changhoon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jeik Byun
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dayoung Ko
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hee-Beom Yang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joong Kee Youn
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
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Hepatic vascular variations and visual three-dimensional reconstruction technique in pediatric patients with choledochal cyst. Surg Radiol Anat 2020; 42:1489-1499. [PMID: 33040160 DOI: 10.1007/s00276-020-02590-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/29/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of the present study was to identify the hepatic vascular variations with visual three-dimensional (3D) reconstruction of vessels in pediatric patients with choledochal cyst (CDC). METHODS We retrospectively analyzed the data of 84 children with pathologically confirmed CDCs treated in the Children's Hospital of Soochow University. 180 patients without CDCs as a control to analysis the hepatic artery and portal vein anatomy. All patients were examined by multi-slice spiral CT (MSCT) and the images of children with CDC were reconstructed by Hisense computer-assisted surgery system (Hisense CAS) to obtain visual 3D images. RESULTS There were 71 females and 13 males diagnosed with CDC. According to Todani classification of CDC, there were 42 cases of type Ia, 10 cases of type Ic and 32 cases of type IVa. There were 10 (11.9%) patients with hepatic artery variations, 14 (16.7%) patients with right hepatic artery located on the ventral side of the CDC, and 16 (19.0%) patients with portal vein variations. Sex, age and types of the cyst were not associated with the presence of vascular variations. There was no significant difference in hepatic vascular variation between CDCs and control groups. Visual 3D images clearly displayed the hepatic vascular variations and the spatial structure of the CDC in pediatric patients with CDC. CONCLUSIONS Hepatic artery and portal vein variations can be detected in pediatric patients with CDC. Visual 3D technique can visually and stereoscopically display the anatomical variations of the hepatic artery and portal vein.
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8
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Reis de Sousa M, Santiago I, Barata MJ, Castillo M, Matos C. Intracholecystic papillary-tubular neoplasm in a patient with choledochal cyst and anomalous pancreaticobiliary junction: case report. BJR Case Rep 2019. [DOI: 10.1259/bjrcr.20180079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 75-year-old female incidentally presented with an enhancing intraluminal gallbladder mass, main bile duct dilatation and anomalous pancreaticobiliary junction (APBJ) during the staging of gastric adenocarcinoma. Histopathological analysis confirmed the diagnosis of intracholecystic papillary-tubular neoplasm. Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder are rare gallbladder neoplasms, defined as intramucosal, preinvasive, exophytic, mass forming lesions. An association between choledochal cysts and anomalous pancreaticobiliary junction with gallbladder neoplasms is well known, and this case potentially illustrates gallbladder carcinogenesis related to these biliary anomalies.
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Affiliation(s)
- Marta Reis de Sousa
- Department of Radiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Inês Santiago
- Department of Radiology, Fundação Champalimaud, Lisbon, Portugal
| | - Maria J Barata
- Department of Radiology, Fundação Champalimaud, Lisbon, Portugal
| | - Mireia Castillo
- Department of Pathology, Fundação Champalimaud, Lisbon, Portugal
| | - Celso Matos
- Department of Radiology, Fundação Champalimaud, Lisbon, Portugal
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9
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Guo WL, Zhan Y, Fang F, Huang SG, Deng YB, Zhao JG, Wang J. Factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of congenital choledochal malformation: a retrospective case study in Southeast China. BMJ Open 2018; 8:e022162. [PMID: 29804066 PMCID: PMC5988190 DOI: 10.1136/bmjopen-2018-022162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of congenital choledochal malformation (CCM). DESIGN A 3-year retrospective study was undertaken between January 2013 and December 2015 in four centres in China. SETTING This involved a retrospective chart review of paediatric patients with CCM in four large hospitals in Southeast China. PARTICIPANTS Sixty-five paediatric patients with CCM were included in this study. We derived all available information on patient demographics, clinical characteristics, preoperative complications and surgical methods from the charts of all these patients. INTERVENTIONS Univariate and multivariate logistic regression analyses were used to evaluate factors significantly affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of CCM. RESULTS Twenty-three of the 65 case surgeries were performed using laparoscopic technique, and 42 surgeries were performed by conventional open surgery. The median operating time was 215 min (range 120-430 min). The morphological subtype of CCM and the presence of cholecystitis or cholangitis were the only factors found to affect the operating time (p<0.05). Logistic regression analysis confirmed cholangitis as an independent risk factor. CONCLUSIONS The morphological subtype of CMM and the presence of cholecystitis or cholangitis are factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of CCM, whereas cholangitis is an independent risk factor.
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Affiliation(s)
- Wan-liang Guo
- Department of Radiology, Children’s Hospital of Soochow University, Suzhou, China
| | - Yang Zhan
- Department of Radiology, Children’s Hospital of Soochow University, Suzhou, China
| | - Fang Fang
- Pediatric Research Center, Children’s Hospital of Soochow University, Suzhou, China
| | - Shun-gen Huang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Yan-bing Deng
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Jun-gang Zhao
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Jian Wang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
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10
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Fan F, Xu DP, Xiong ZX, Li HJ, Xin HB, Zhao H, Zhang JW. Clinical significance of intrapancreatic choledochal cyst excision in surgical management of type I choledochal cyst. J Int Med Res 2018; 46:1221-1229. [PMID: 29322850 PMCID: PMC5972235 DOI: 10.1177/0300060517728598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/07/2017] [Indexed: 01/29/2023] Open
Abstract
Objective To investigate the effectiveness of intrapancreatic choledochal cyst excision in treating type I choledochal cyst, and increase understanding of the need for thorough surgical management of the disease. Methods Primary and secondary (including multiple) surgical cases, treated between 2005 and 2015, were retrospectively analysed, and follow-up data of post-treatment effectiveness to date were reviewed. Differences in curative effects were compared between whole and partial excision of the choledochal cyst. Results Out of 350 cases, patients with whole excision of the choledochal cyst ( n = 272) experienced no associated symptoms in the long-term (3/272 [1.1%] experienced stomach ache or fever). Patients with partial resection of the choledochal cyst ( n = 78) developed associated symptoms, including new cyst, calculus of the bile duct (51/78 [65.4%]), and carcinogenesis (11/78 [14.1%]) in the residual intrapancreatic biliary duct. Post-treatment clinical manifestations were significantly different between patients with partial resection versus whole excision of the choledochal cyst ( P<0.05). Conclusion Surgical re-excision should be considered in patients with a residual intrapancreatic portion of the choledochal cyst due to prior incomplete surgery, regardless of clinical symptoms.
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Affiliation(s)
- Fei Fan
- Department of Special Treatment II, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Da-Peng Xu
- Department of General Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Zheng-Xiang Xiong
- Department of Special Treatment II, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Hai-Jia Li
- Department of General Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Hai-Bei Xin
- Department of General Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Huan Zhao
- Department of General Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Jin-Wei Zhang
- Department of General Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
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11
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Kolli S, Etienne D, Reddy M, Shahzad G. A Review of Double Common Bile Duct and Its Sequelae. Gastroenterology Res 2018; 11:1-4. [PMID: 29511398 PMCID: PMC5827894 DOI: 10.14740/gr950w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 11/12/2022] Open
Abstract
A double or accessory common bile duct (ACBD) is a rare congenital anomaly. We report the case of a 60-year-old American Asian male, who was found to have a double or duplicated common bile duct after being admitted for evaluation of a pancreatic mass. A duplicated bile duct has the same mucosa histologically as a single bile duct. However, the opening of a duplicated bile duct lacks a sphincter allowing retrograde flow of gut contents which results in a higher probability of intraductal calculus formation. On rare occasions, it can predispose to liver abscesses, pancreatitis, pancreatic cancer, gallbladder cancer, gastric cancer, and ampullary cancer depending on the location of the opening of the ACBD. We present an integrative review of the limited cases of ACBD with correlation to the current case and discussion regarding the aspects of diagnosis and management.
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Affiliation(s)
- Sindhura Kolli
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
| | - Denzil Etienne
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
| | - Madhavi Reddy
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
| | - Ghulamullah Shahzad
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
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12
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Soares KC, Goldstein SD, Ghaseb MA, Kamel I, Hackam DJ, Pawlik TM. Pediatric choledochal cysts: diagnosis and current management. Pediatr Surg Int 2017; 33:637-650. [PMID: 28364277 DOI: 10.1007/s00383-017-4083-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 02/07/2023]
Abstract
Choledochal cysts are rare congenital disorders first described by Vater and Ezler in 1723. Their exact etiology remains incompletely understood; however, an anomalous pancreaticobiliary union (APBDU) and subsequent reflux of biliary contents into the biliary tree are thought to play a role. Accordingly, APBDU-associated choledochal cyst patients are significantly more likely to have evidence of hepatitis, cholangitis or pancreatitis and pathologically confirmed inflammation. In 1977, Todani and colleagues modified the original Alonso-Lej classification to include five types of CC. Type I and IV are the most common and most likely to be associated with malignancy. The majority of choledochal cysts are diagnosed in childhood. Clinical presentation varies and most often consists of nonspecific abdominal pain. Diagnosis is typically accomplished using multimodality imaging techniques including computed tomography, magnetic resonance imaging, ultrasound and MRCP. The use of diagnostic PTC and ERCP in CC has been largely replaced by MRCP. Appropriate management consists of prompt, complete cyst excision followed by restoration of biliary enteric continuity when necessary. Minimally invasive CC resection in the pediatric population has demonstrated acceptable outcomes. Prognosis is generally excellent; however, malignancy risk remains higher than the general population even after complete surgical excision.
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Affiliation(s)
- Kevin C Soares
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Blalock 688, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Seth D Goldstein
- Division of General Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mounes A Ghaseb
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab Kamel
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David J Hackam
- Division of General Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Department of Surgery, Wexner Medical Center, Ohio State University, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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13
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Management of Complicated Choledochal Cyst in an Adult with Situs Inversus Totalis: Diagnostic Difficulties and Technical Notes. Indian J Surg 2017; 79:464-467. [PMID: 29089712 DOI: 10.1007/s12262-017-1613-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/02/2017] [Indexed: 10/20/2022] Open
Abstract
Situs inversus totalis is the mirror image of situs solitus, the normal position of abdominal and thoracic viscera. Many associated intraabdominal anomalies have been described with this condition. However, association of choledochal cyst with situs inversus has never been reported. Diagnosis and surgical procedures for abdominal pathology in patients with situs inversus totalis are technically more complicated and pose unique challenges because of left-right transposition of the visceral organs. The choledochal cyst is usually diagnosed in the neonatal period or during childhood. The clinical symptoms are nonspecific and usually include pain in the right upper quadrant and jaundice. The condition may also present with biliary colic, cholangitis, cholelithiasis or pancreatitis. In our case, the abdominal ultrasonography performed on a 55-year-old female who presented to us with jaundice, fever and pain in the left upper abdomen revealed presence of situs inversus with fusiform dilation of the common bile duct. Based on the magnetic resonance cholangiopancreatography (MRCP) images diagnosis of type I choledochal cyst was made. The aim of this case report is to illustrate an extremely rare association of situs inversus totalis with choledochal cyst along with the challenges faced in diagnosis and surgical management of this condition.
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14
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Liu N, Huang XH, Zhang XM, Dong GL, Jing ZL, Gao CL, Tang MY. The angle of pancreaticobiliary junction correlates with acute pancreatitis: a magnetic resonance cholangiopancreatography study. Quant Imaging Med Surg 2015; 5:401-6. [PMID: 26029643 DOI: 10.3978/j.issn.2223-4292.2015.03.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/13/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study the correlation between the angle of the pancreaticobiliary junction (APJ) and the prevalence of acute pancreatitis using magnetic resonance cholangiopancreatography (MRCP). MATERIALS AND METHODS From February 2014 to October 2014, thirty two subjects with normal pancreas (group A) and 40 patients with acute pancreatitis (group B) who underwent MRCP were enrolled into our study. The type of biliary duct and main pancreatic duct joining the duodenal wall was reviewed and divided into V, B-P and P-B type. The V type is the pancreatic duct and biliary duct joining the duodenal wall without a common channel; the B-P type is the biliary duct draining into the pancreatic duct and forming a common channel; and the P-B type is the pancreatic duct draining into the biliary duct and forming a common channel. APJ was measured on MRCP. The correlation between the APJ and the prevalence of acute pancreatitis was analyzed. RESULTS The APJ in group A was smaller than in group B (51.45°±13.51° vs. 65.76°±15.61°, P<0.05). According to the type of biliary duct and main pancreatic duct joining the duodenal wall, the prevalence of acute pancreatitis in the V type and in the B-P type was higher than in the P-B type (12/17 vs. 10/29, or 18/26 vs. 10/29, respectively, all P<0.05), whereas there were no significant difference for the prevalence of acute pancreatitis between the V type and B-P type (P>0.05). The APJ were 59.32°±20.04°, 60.22°±11.06°, 57.13°±17.27°, respectively in V type, B-P type and P-B type joining of main pancreatic duct (P>0.05). CONCLUSIONS A larger APJ is related to a higher prevalence of acute pancreatitis.
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Affiliation(s)
- Nian Liu
- Department of Radiology, Affiliated Hospital North Sichuan Medical College, Nanchong 637000, China
| | - Xiao-Hua Huang
- Department of Radiology, Affiliated Hospital North Sichuan Medical College, Nanchong 637000, China
| | - Xiao-Ming Zhang
- Department of Radiology, Affiliated Hospital North Sichuan Medical College, Nanchong 637000, China
| | - Guo-Li Dong
- Department of Radiology, Affiliated Hospital North Sichuan Medical College, Nanchong 637000, China
| | - Zong-Lin Jing
- Department of Radiology, Affiliated Hospital North Sichuan Medical College, Nanchong 637000, China
| | - Cai-Liang Gao
- Department of Radiology, Affiliated Hospital North Sichuan Medical College, Nanchong 637000, China
| | - Meng-Yue Tang
- Department of Radiology, Affiliated Hospital North Sichuan Medical College, Nanchong 637000, China
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15
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Laparoscopic versus open surgery in children with choledochal cysts: a meta-analysis. Pediatr Surg Int 2015; 31:529-34. [PMID: 25895070 DOI: 10.1007/s00383-015-3705-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the safety and efficacy between laparoscopic and open cyst excision with hepaticojejunostomy for children with choledochal cysts using meta-analysis. METHODS Studies comparing the laparoscopic and the open choledochal cyst excision that met the inclusion criteria for data extraction were identified from electronic databases (PubMed, Embase, Science Citation Index, and the Cochrane Library) up to November 2014. The proceedings of relevant congress were also searched. The outcomes were operative time, intraoperative blood loss, time to food intake, postoperative morbidity and mortality, length of hospital stay. Outcomes were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using RevMan 5.2. RESULTS Seven retrospective studies were finally included, involving a total of 1016 patients, of whom, 408 cases underwent laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy (LH) and 608 cases underwent open cyst excision and Roux-en-Y hepaticojejunostomy (OH). In LH group compared with OH group, the operative time was longer (MD = 59.11, 95% CI 27.61-90.61, P = 0.0002), while the length of postoperative hospital stay was less (MD = -2.01, 95% CI -2.49 to -1.54, P < 0.00001), the intraoperative blood loss was lower (MD = -37.14, 95% CI -66.69 to -7.60, P = 0.01) and time to food intake was less (MD = -1.14, 95% CI -1.61 to -0.67, P = 0.01). The rate of postoperative morbidity was more in the OH group, but there is no statistically significant difference between the two groups in postoperative morbidity (OR = 0.52, 95% CI 0.13-2.06, P = 0.35). CONCLUSION Laparoscopic surgery is a feasible, safe treatment of choledochal cyst with less postoperative morbidity, a shorter length of stay and a lower blood loss when compared with open approach. With the improvement of laparoscopic techniques and deftness of surgeons practice, laparoscopic surgery may become the first choice procedure for choledochal cyst.
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