Management Of Choledochal Cysts In Adults

Objective:Choledochal cysts in adults require proper diagnosis and treatment to address associated symptoms, risk of malignancy, and disease progression. The purpose of this study is to investigate the most suitable diagnostic modalities and treatment of adult choledochal cyst.Methods:A total of72patients with choledochal cysts admitted to the Hepatobiliary Surgery Department of Qilu Hospital and Shanxian Central Hospital, were included in the study during the years2004-2009. There were6cases complicated with malignant tumors in the cysts. Including four patients with multiple organ metastasis, did not receive surgical treatment. Overall68patients in this study underwent surgery.Results:Among the72cases, there were52female and20male patients whose ages ranged from18to67years with a median age of31years. The patients were classified according to Todani Classification and the incidence rate observed for type I, IVa and IVb were41,28and3cases, respectively. Complete cyst resection and Roux-en-Y hepaticojejunostomy was performed in66patients, combined with partial hepatectomy in17patients. One patient received pancreaticoduodenectomy and1routine choledochal cyst resection combined with left hepatectotny. There was no surgical mortality, early and long-term postoperative complications occured in6(9%) and8patients (12%) respectively. The follow-up time stretched from I to8years. Four cases with malignant choledocal cysts that had not undergone surgery died within2years after diagnosis.Conclusion:The identification and early diagnosis of choledochal cyst is very important in preventing future complications. We recommend complete cyst resection and Roux-en-Y hopaticojejunostomy as the procedure of choice to extend patient’s survival time and improve their quality of life.