Current status and experience of treatment in choledochal cyst_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Mingtai ¹ ,  JIANG Xiaoqing ²

1. Department of Hepatobiliary and Pancreatic Surgery, Dongfang Hospital Affiliated to Shanghai Tongji University, Shanghai 200120, P. R. China;
2. Department Ⅰ of Biliary Tract Surgery, The Third Affiliated Hospital of Naval Medical University (Shanghai Eastern Hepatobiliary Surgery Hospital ), Shanghai 200438, P. R. China;

Corresponding author：

JIANG Xiaoqing, Email: jxqehbh@sina.com

Keywords：

choledochal cyst; etiology; classification; cyst excision; prognosis

DOI：

10.7507/1007-9424.202210018

Video：

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Choledochal cysts are characterized by single or multiple cystic dilatations of the intrahepatic and / or extrahepatic biliary ducts. The typical presentation of this condition is non-specific. Clinicians must have a high clinical suspicion of choledochal cysts while investigating patients with jaundice, abdominal pain, and abdominal mass. There are multiple classifications for choledochal cysts . The Todani classification system is the most widely used in clinical practice. Based on clinical practice and thinking, we established a new “three regions and five types” classification system on the basis of Todani classification to guide clinical work, but further verification is needed. Surgery is the mainstay of treatment for choledochal cysts and the approach depends on the cyst type and the extent of hepatobiliary pathology. The principles of treatment include complete excision of the cyst and restoration of biliary-intestinal continuity. In view of the risk of biliary malignancy continues to be high after surgery, long-term follow-up is strongly recommended.

Citation： HU Mingtai, JIANG Xiaoqing. Current status and experience of treatment in choledochal cyst. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(1): 18-22. doi: 10.7507/1007-9424.202210018 Copy

1.	Vater A, Ezler CS. Dissertatio de Scirrhis viserum occasione sections viri tymponite defunte. Wittenburgae Pamphlets, 1723, 4: 22.
2.	Soares KC, Arnaoutakis DJ, Kamel I, et al. Choledochal cysts: presentation, clinical differentiation, and management. J Am Coll Surg, 2014, 219(6): 1167-1180.
3.	Soares KC, Kim Y, Spolverato G, et al. Presentation and clinical outcomes of choledochal cysts in children and adults: a multi-institutional analysis. JAMA Surg, 2015, 150(6): 577-584.
4.	Xia HT, Yang T, Liang B, et al. Treatment and outcomes of adults with remnant intrapancreatic choledochal cysts. Surgery, 2016, 159(2): 418-425.
5.	Lee SE, Jang JY, Lee YJ, et al. Choledochal cyst and associated malignant tumors in adults: a multicenter survey in South Korea. Arch Surg, 2011, 146(10): 1178-1184.
6.	Babbitt DP. 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.
7.	Tajiri T, Tate G, Inagaki T, et al. Mucinous cystadenoma of the pancreas 17 years after excision of gallbladder because of a choledochal cyst. J Gastroenterol, 2004, 39(2): 181-187.
8.	Park SW, Koh H, Oh JT, et al. Relationship between anomalous pancreaticobiliary ductal union and pathologic inflammation of bile duct in choledochal cyst. Pediatr Gastroenterol Hepatol Nutr, 2014, 17(3): 170-177.
9.	Imazu M, Iwai N, Tokiwa K, et al. Factors of biliary carcinogenesis in choledochal cysts. Eur J Pediatr Surg, 2001, 11(1): 24-27.
10.	Levy AD, Rohrmann CA, Murakata LA, et al. Caroli’s disease: radiologic spectrum with pathologic correlation. AJR Am J Roentgenol, 2002, 179(4): 1053-1057.
11.	Kusunoki M, Yamamura T, Takahashi T, et al. Choledochal cyst. Its possible autonomic involvement in the bile duct. Arch Surg, 1987, 122(9): 997-1000.
12.	Martin RF. Biliary cysts: a review and simplified classification scheme. Surg Clin North Am, 2014, 94(2): 219-232.
13.	Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg, 1977, 134(2): 263-269.
14.	徐畅, 程庆保, 吴小兵, 等. 磁共振胆胰管造影数字量化诊断法在鉴别Ⅰc型胆总管囊肿中的应用. 中华肝胆外科杂志, 2019, 25(12): 905-909.
15.	Bhavsar MS, Vora HB, Giriyappa VH. Choledochal cysts: a review of literature. Saudi J Gastroenterol, 2012, 18(4): 230-236.
16.	Gorenstein L, Strasberg SM. Etiology of choledochal cysts: two instructive cases. Can J Surg, 1985, 28(4): 363-367.
17.	Ronnekleiv-Kelly SM, Soares KC, Ejaz A, et al. Management of choledochal cysts. Curr Opin Gastroenterol, 2016, 32(3): 225-231.
18.	李斌, 邱智泉, 刘辰, 等. 先天性胆管囊肿外科治疗要点及“三类五型”分型系统的临床意义. 中华肝胆外科杂志, 2021, 27(2): 86-90.
19.	Ray S, Bhat BK, Yadav A, et al. Isolated dilatation of the cystic duct-type Ⅵ choledochal cyst: a rare case presentation and review of the literature. J Surg Case Rep, 2017, 2017(4): rjx067. doi: 10.1093/jscr/rjx067.
20.	Budipramana VS, Saraswati PA. Type Ⅵ choledochal cyst: a case report. Int J Surg Case Rep, 2020, 68: 111-114.
21.	李斌, 邱智泉, 姜小清. 先天性胆管囊肿“三类五型”分型系统及手术治疗要点. 中华肝脏外科手术学电子杂志, 2021, 10(5): 442-445.
22.	李斌, 邱智泉, 刘辰, 等. 改进外科治疗策略规避Ⅰ型和Ⅳ型先天性胆管囊肿术后并发症. 中华肝胆外科杂志, 2016, 22(12): 848-851.
23.	Saeki I, Takahashi Y, Matsuura T, et al. Successful endoscopic unroofing for a pediatric choledochocele. J Pediatr Surg, 2009, 44(8): 1643-1645.
24.	Visser BC, Suh I, Way LW, et al. Congenital choledochal cysts in adults. Arch Surg, 2004, 139(8): 855-860.
25.	李斌, 姜小清, 易滨, 等. “计划性肝切除”体系的肝门部胆管癌Bismuth-Corlette改进分型. 中国实用外科杂志, 2018, 38(6): 679-683.
26.	李斌, 邱智泉, 刘辰, 等. 计划性肝切除在“中央型”肝内外胆管囊肿治疗中的应用. 中华肝胆外科杂志, 2017, 23(9): 619-623.
27.	Mabrut JY, Kianmanesh R, Nuzzo G, et al. Surgical management of congenital intrahepatic bile duct dilatation, Caroli’s disease and syndrome: long-term results of the French Association of Surgery Multicenter Study. Ann Surg, 2013, 258(5): 713-721.
28.	Ono S, Fumino S, Shimadera S, et al. Long-term outcomes after hepaticojejunostomy for choledochal cyst: a 10- to 27-year follow-up. J Pediatr Surg, 2010, 45(2): 376-378.
29.	Ten Hove A, de Meijer VE, Hulscher JBF, et al. Meta-analysis of risk of developing malignancy in congenital choledochal malformation. Br J Surg, 2018, 105(5): 482-490.
30.	Mihalache F, Tantau M, Diaconu B, et al. Survival and quality of life of cholangiocarcinoma patients: a prospective study over a 4 year period. J Gastrointestin Liver Dis. 2010, 19(3): 285-290.
31.	Gomes C, Tivnan P, McAneny D, et al. Choledochal cyst or benign biliary dilation: is resection always necessary? J Gastrointest Surg, 2021, 25(9): 2353-2357.

1. Vater A, Ezler CS. Dissertatio de Scirrhis viserum occasione sections viri tymponite defunte. Wittenburgae Pamphlets, 1723, 4: 22.
2. Soares KC, Arnaoutakis DJ, Kamel I, et al. Choledochal cysts: presentation, clinical differentiation, and management. J Am Coll Surg, 2014, 219(6): 1167-1180.
3. Soares KC, Kim Y, Spolverato G, et al. Presentation and clinical outcomes of choledochal cysts in children and adults: a multi-institutional analysis. JAMA Surg, 2015, 150(6): 577-584.
4. Xia HT, Yang T, Liang B, et al. Treatment and outcomes of adults with remnant intrapancreatic choledochal cysts. Surgery, 2016, 159(2): 418-425.
5. Lee SE, Jang JY, Lee YJ, et al. Choledochal cyst and associated malignant tumors in adults: a multicenter survey in South Korea. Arch Surg, 2011, 146(10): 1178-1184.
6. Babbitt DP. 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.
7. Tajiri T, Tate G, Inagaki T, et al. Mucinous cystadenoma of the pancreas 17 years after excision of gallbladder because of a choledochal cyst. J Gastroenterol, 2004, 39(2): 181-187.
8. Park SW, Koh H, Oh JT, et al. Relationship between anomalous pancreaticobiliary ductal union and pathologic inflammation of bile duct in choledochal cyst. Pediatr Gastroenterol Hepatol Nutr, 2014, 17(3): 170-177.
9. Imazu M, Iwai N, Tokiwa K, et al. Factors of biliary carcinogenesis in choledochal cysts. Eur J Pediatr Surg, 2001, 11(1): 24-27.
10. Levy AD, Rohrmann CA, Murakata LA, et al. Caroli’s disease: radiologic spectrum with pathologic correlation. AJR Am J Roentgenol, 2002, 179(4): 1053-1057.
11. Kusunoki M, Yamamura T, Takahashi T, et al. Choledochal cyst. Its possible autonomic involvement in the bile duct. Arch Surg, 1987, 122(9): 997-1000.
12. Martin RF. Biliary cysts: a review and simplified classification scheme. Surg Clin North Am, 2014, 94(2): 219-232.
13. Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg, 1977, 134(2): 263-269.
14. 徐畅, 程庆保, 吴小兵, 等. 磁共振胆胰管造影数字量化诊断法在鉴别Ⅰc型胆总管囊肿中的应用. 中华肝胆外科杂志, 2019, 25(12): 905-909.
15. Bhavsar MS, Vora HB, Giriyappa VH. Choledochal cysts: a review of literature. Saudi J Gastroenterol, 2012, 18(4): 230-236.
16. Gorenstein L, Strasberg SM. Etiology of choledochal cysts: two instructive cases. Can J Surg, 1985, 28(4): 363-367.
17. Ronnekleiv-Kelly SM, Soares KC, Ejaz A, et al. Management of choledochal cysts. Curr Opin Gastroenterol, 2016, 32(3): 225-231.
18. 李斌, 邱智泉, 刘辰, 等. 先天性胆管囊肿外科治疗要点及“三类五型”分型系统的临床意义. 中华肝胆外科杂志, 2021, 27(2): 86-90.
19. Ray S, Bhat BK, Yadav A, et al. Isolated dilatation of the cystic duct-type Ⅵ choledochal cyst: a rare case presentation and review of the literature. J Surg Case Rep, 2017, 2017(4): rjx067. doi: 10.1093/jscr/rjx067.
20. Budipramana VS, Saraswati PA. Type Ⅵ choledochal cyst: a case report. Int J Surg Case Rep, 2020, 68: 111-114.
21. 李斌, 邱智泉, 姜小清. 先天性胆管囊肿“三类五型”分型系统及手术治疗要点. 中华肝脏外科手术学电子杂志, 2021, 10(5): 442-445.
22. 李斌, 邱智泉, 刘辰, 等. 改进外科治疗策略规避Ⅰ型和Ⅳ型先天性胆管囊肿术后并发症. 中华肝胆外科杂志, 2016, 22(12): 848-851.
23. Saeki I, Takahashi Y, Matsuura T, et al. Successful endoscopic unroofing for a pediatric choledochocele. J Pediatr Surg, 2009, 44(8): 1643-1645.
24. Visser BC, Suh I, Way LW, et al. Congenital choledochal cysts in adults. Arch Surg, 2004, 139(8): 855-860.
25. 李斌, 姜小清, 易滨, 等. “计划性肝切除”体系的肝门部胆管癌Bismuth-Corlette改进分型. 中国实用外科杂志, 2018, 38(6): 679-683.
26. 李斌, 邱智泉, 刘辰, 等. 计划性肝切除在“中央型”肝内外胆管囊肿治疗中的应用. 中华肝胆外科杂志, 2017, 23(9): 619-623.
27. Mabrut JY, Kianmanesh R, Nuzzo G, et al. Surgical management of congenital intrahepatic bile duct dilatation, Caroli’s disease and syndrome: long-term results of the French Association of Surgery Multicenter Study. Ann Surg, 2013, 258(5): 713-721.
28. Ono S, Fumino S, Shimadera S, et al. Long-term outcomes after hepaticojejunostomy for choledochal cyst: a 10- to 27-year follow-up. J Pediatr Surg, 2010, 45(2): 376-378.
29. Ten Hove A, de Meijer VE, Hulscher JBF, et al. Meta-analysis of risk of developing malignancy in congenital choledochal malformation. Br J Surg, 2018, 105(5): 482-490.
30. Mihalache F, Tantau M, Diaconu B, et al. Survival and quality of life of cholangiocarcinoma patients: a prospective study over a 4 year period. J Gastrointestin Liver Dis. 2010, 19(3): 285-290.
31. Gomes C, Tivnan P, McAneny D, et al. Choledochal cyst or benign biliary dilation: is resection always necessary? J Gastrointest Surg, 2021, 25(9): 2353-2357.

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Current status and experience of treatment in choledochal cyst

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