CYST EXCISION AND REPLACEMENT OF THE CHOLEDOCHUS BY A JEJUNAL SEGMENT FOR CHOLEDOCHAL CYST: EXPERIENCES WITH 73 CASES

NGUYEN THANH LIEM

National Hospital of Pediatrics

Giangvo, Hanoi, Vietnam

Purpose

To present early result of cyst excision and replacement of the choledochus by a jejunal segment.

Methods

From November 1997 to August 2000, 73 children were operated by the same surgeon. The cyst was separated from the vessels and transected in the middle. The orifice of the common pancreaticobiliary channel (CPBC) was looked for in the base of the cyst. The cyst was removed up to the common hepatic duct and down to the orifice of CPBC. A jejunal segment of 25cm in length was used to anastomose with the common hepatic duct and the duodenum. An antireflux valve was created on the duodenal side.

Results

Ặf the 73 children, 57 (78%) were female and 16 (22%) were male. 58 children (79%) presented with an abdominal pain, 36 (49%) with jaundice and 8 (11%) with an abdominal mass. Ặnly eight patients (11%) presented with the classic triad.

The choledochal diameter ranged from 1.5cm - 15cm : 37 patients had the choledochal diameter £ 4cm, 36 cases had the choledochal diameter > 4cm. Ặf 27 children whose choledochal terminus was identified on cholangiography, 26 had the CPBC (96.3%).

There was no postoperative mortality. Biliary fistulas occurred in one patient and resolved spontaneously.

Conclusion

The procedure is safe and physiological without mortality and has a very low complication rate.

Back