Details
Category: Volume 06 Issue 05 May 2018
Hits: 1472

Title: Hepaticojejunostomy & Hepaticoduodenostomy in Biliary Reconstruction Following Excision of Choledochal Cyst – Which Is Better?

Authors: Dr Samir Gupta, Dr Tanmay Anand, Dr Achal Gupta

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.30

Abstract

Choledochal cysts are rare congenital dilations of the biliary tree that can present with non-specific symptoms such as abdominal pain, jaundice, cholelithiasis and pancreatitis. Although most commonly identified in children, they can be found in the adult population.

The incidence of choledochal cysts in the western population is 1:100,000–1: 150,000 live births. The rate is remarkably higher in Asian populations, with approximately two-thirds of cases occurring in Japan.

Cystic disease of the biliary tree was first described in 1723, and the first classification system for choledochal cysts was proposed by Alonso-Lej et al. in 1959 Contemporary classification was created by Todani et al. in 1977 (Figure 1).

The aetiology of the choledochal cyst remains unclear. The most accepted theory of cyst origin supposes the influence of an abnormal pancreatobiliary junction when the common channel of the pancreatic and bile duct exists. This theory postulates that the exceptionally long common channel allows mixing of the pancreatic and biliary juices, resulting in the activation of pancreatic enzymes, inflammation, and deterioration of the biliary duct wall, leading toits dilatation. The origin of type-V choledochal cysts probably differs from that of the other types of choledochal cysts, and is possibly due to dysfunctional remodelling of the ductal plate during embryogenesis.

The relationship between choledochal cysts and carcinogenesis is important. The choledochal cyst is apremalignant state in which cancer occurs not only more often but also 10–15 years earlier than in the normal population. The overall risk of cancer has been reported to be 10–15%, and it increases with age.

References

  1. Yeung F, Chung PH, Wong KK, Tam PK. Biliary-enteric reconstruction with hepaticoduodenostomy following laparoscopic excision of choledochal cyst is associated with better postoperative outcomes: a single-centre experience. Pediatr Surg Int. 2015 Feb; 31(2):149-53.
  2. Narayanan SK, Chen Y, Narasimhan KL, Cohen RC. Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: a systematic review and meta-analysis. Journal of Pediatric Surgery 2013; 48(11): 2336-2342
  3. Santore MT, Behar BJ, Blinman TA, Doolin EJ, Hedrick HL, Mattei P, Nance ML, Adzick NS, Flake AW. Hepaticoduo-denostomy vs hepaticojejunostomy for reconstruction after resection of choledochal cyst. J Pediatr Surg. 2011 Jan; 46(1):209-13.
  4. Abbas HM, Yassin NA, Ammori BJ. Laparoscopic resection of type I choledochal cyst in an adult and Roux-en-Y hepaticojejunostomy: a case report and literature review. Surg Laparosc Endosc Percutan Tech. 2006 Dec; 16(6):439-44
  5. Zhen C, Xia Z, Long L, LishuangM. Laparoscopic excision versus open excision for the treatment of choledochal cysts: a systematic review and meta-analysis.Int Surg. 2015 Jan;100(1):115-22.
  6. Dalton BG, Gonzalez KW, Dehmer JJ, Andrews WS, Hendrickson RJ. Transition of Techniques to Treat Choledochal Cysts in Children. J Laparoendosc Adv Surg Tech A. 2016 Jan;26 (1):62-5. doi: 10.1089/lap.2015.0123.
  7. Urushihara N, Fukumoto K, Fukuzawa H, Mitsunaga M, Watanabe K, Aoba T, Yamoto M, Miyake H. Long-term outcomes after excision of choledochal cysts in a single institution: operative procedures and late complications. J Pediatr Surg. 2012 Dec;47(12):2169-74. doi: 10.1016/j.jpedsurg.2012.09.001.
  8. Shimotakahara A, Yamataka A, Yanai T, Kobayashi H, Okazaki T, Lane GJ, Miyano T. Roux-en-Y hepaticojeju-nostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: which is better? Pediatr Surg Int. 2005 Jan;21(1):5-7.
  9. Diaz Ramos NM, Lugo-Vicente H. Choledochal Cyst: Hepaticoduodenostomy or hepaticojejunostomy? BolAsoc Med P R. 2016;108(1):41-46.
  10. Diao M, Li L, Cheng W To drain or not to drain in Roux-en-Y hepatojejunostomy for children with choledochal cysts in the laparoscopic era: a prospective randomized study. J Pediatr Surg. 2012 Aug;47(8): 1485-9. doi: 10.1016/j.jpedsurg.2011.10.066.

Corresponding Author

Dr Tanmay Anand Surgical Resident