Background:

Bile duct cysts are rare and of uncertain origin. Most have been reported in young females of Asian descent, but an increasing number have occurred in Western adults.



Methods:

A Medline literature search was performed to locate articles on the pathophysiological concepts, clinical behaviour and management controversies pertaining to bile duct cysts in adults. Emphasis was placed on reports from the past two decades.



Results and conclusion:

An increasing rate of occurrence of bile duct cyst is reported in adults. Type IV cysts are more frequent in adults than children. Presentation tends to be non-specific abdominal discomfort. Related hepatobiliary or pancreatic disease frequently precedes recognition, and may complicate the postoperative course. Surgical treatment aims to relieve complications deriving from the cysts and to reduce the significant risk of malignant change within the biliary tree. Complete cyst resection, cholecystectomy and Roux-en- hepaticojejunostomy reconstruction is standard. Controversy exists about the role of hepatic resection in type IV and V cysts, and the role of minimally invasive and laparoscopic treatment. In general, the outcome is good and a near-zero mortality rate has been reported in institutional series over the past decade. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Bile duct cysts in adults.

Hypothesis Choledochal cyst is rarely diagnosed in adulthood. When complicated by biliary tract malignancy, the disease has a distinct presentation and carries a dismal prognosis despite radical surgical resection. Design Retrospective study. Setting Tertiary referral center. Patients A retrospective study was performed on 30 adult patients who presented with choledochal cyst from January 1, 1989, to December 31, 2000. Main Outcome Measures The clinical presentation, management, and outcome of patients with and without biliary tract malignancy. Results Nine patients (30%) had biliary tract malignancy complicating choledochal cyst (group A). Compared with 21 patients without malignancy (group B), group A patients had a significantly higher incidence of previous internal drainage operations for choledochal cyst ( P = .049) and presentation with cholangitis ( P = .03). Four patients in group A underwent pancreaticoduodenectomy and 3 received a palliative biliary drainage operation. The overall median survival of patients in group A was 12 months. Complete excision of choledochal cyst and Roux-en-Y hepaticojejunostomy were performed for all patients in group B, among whom 2 underwent concomitant hemihepatectomy. The operative morbidity and mortality were 14% and 0%, respectively, and there were no long-term complications with a median follow-up of 66 months. Conclusions Biliary tract malignancy complicating choledochal cyst in adults should be suspected in patients with a history of internal drainage of choledochal cyst and presentation with cholangitis. Complete excision of choledochal cyst with Roux-en-Y hepaticojejunostomy is the treatment of choice for patients without malignancy and can be performed with low operative morbidity and absence of long-term complications in adult patients.

/pdf/choledochal-cysts-in-adults-uo3apyexbs.pdf

Choledochal cysts in adults.

Context Choledochal cysts are rare and of unknown cause. Their presentation is protean, with the classical triad of pain, jaundice, and mass rarely seen. The potential complications are serious, including pancreatitis, cholangitis, and cholangiocarcinoma. Objective To present the current experience and evidence relating to all aspects of choledochal cysts to derive appropriate management recommendations. Methods Review of relevant literature in the English language indexed on MEDLINE. Results The elaboration of the classification of choledochal cysts. We describe the modes of presentation and optimal investigation and summarize the current theories on etiology and malignant transformation. The results of different management strategies are presented. Conclusions Choledochal cysts are often detected during the investigation of nonspecific symptoms, or even incidentally detected. Magnetic resonance imaging is the best imaging modality for the diagnosis and characterization of these cysts. Complete excision and hepaticojejenostomy is the management of choice.

https://jamanetwork.com/journals/jamasurgery/articlepdf/394516/srv2007.pdf

Management dilemmas with choledochal cysts.

Objective To assess the type and rate of complications in the postoperative period of pediatric patients undergoing the Sistrunk procedure.

Study Design A retrospective review of patients with a diagnosis of thyroglossal duct cyst who had not had corrective surgery previously. An attempt to standardize the study was made as follows: all patients had surgery under the direction of one surgeon, using the Sistrunk procedure with minor modifications from its original description. Complications were divided into major and minor categories.

Methods Charts were reviewed for age, se-, preoperative assessment, and postoperative follow-up. Complications were recorded. A postoperative telephone survey was conducted.

Results A minor complication rate of 29% was observed. There were no recurrences or major complications.

Conclusions The Sistrunk procedure remains the operation of choice for removal of the thyroglossal duct cyst. When the surgery is properly performed, with attention to key surgical landmarks, the risk of major complication is minimal. Complications that do occur are minor and wound related.

Complications associated with the Sistrunk procedure.

Background. Choledochal cysts are dilations of the biliary tree. Although commonly reported in Asian populations, the incidence outside of Asia is as low as 1:150 000. The largest series of patients with choledochal cyst disease outside of Asia is this one, studying 70 patients treated in Vancouver between 1971 and 2003. Patients and methods. This was a retrospective chart review. Results. In all, 19 paediatric and 51 adult patients were evaluated; 21% of paediatric and 25% of adult patients were Asian. All paediatric patients had type I or IV cysts, whereas adult patients represented the different subtypes. Abdominal pain was the presenting symptom in 79% of children and 88% of adults, vomiting was present in 42% of children and 63% of adults and jaundice was seen in 31.5% of children and 39% of adults. Ultrasound was used in 94.7% of children, and ERCP in 80% of adults. In all, 84% of paediatric patients, 100% of adult patients with type I cysts and 85.7% of adult patients with type IV cysts received complete cyst excision and Roux-en-Y hepaticojejunostomy. Complications in both groups were low. Conclusions. Although Vancouver does have a large Asian population, this does not explain how common choledochal cysts are in this city. Alhough some authors argue that paediatric and adult disease are caused by different aetiologies, presentation patterns in our study between the two groups were very similar. We recommend complete cyst excision and Roux-en-Y hepaticojejunostomy as the surgery of choice, and advocate early surgery after diagnosis to promote ease of surgery and prevention of future complications.

http://www.polysalov.vipvrach.ru/download/Choledochal_cysts.pdf

Choledochal cysts: analysis of disease pattern and optimal treatment in adult and paediatric patients.

Choledochal cyst in adult

From 1983 to 1989, ninety-two in hospital cases of surgically treated thyroglossal duct cysts were reviewed. 4 patients (4%) were found to have metaplastic changes of the lining epithelium. Recurrence and the potential for malignancy are two main problems in the treatment of thyroglossal duct cyst. We advocate the Sistrunk procedure to be the choice of surgical treatment for thyroglossal duct cyst.

Thyroglossal duct cyst: an analysis of 92 cases.

BACKGROUND The development of hepatobiliary imaging modalities has resulted in earlier detection of gallbladder cancer. This is a retrospective evaluation of surgical resection of gallbladder cancer. METHODS Records of 58 patients with gallbladder carcinoma who underwent surgical resection in the past 14 years were examined. Patients were staged according to the Nevin system: six had Nevin stage I disease; 10, stage II; 9, stage III; four, stage IV; and 24 had stage V cancer. Forty-three patients were thought to have resectable lesions. Of these, 14 had extended cholecystectomy, 21 simple cholecystectomy, seven simple cholecystectomy with biliary drainage and one patient had radical cholecystectomy with pancreaticoduodenectomy. Prognoses were analyzed in relation to pathologic staging and surgical procedures. RESULTS The overall one-year and five-year survival rates were 50% and 19.2%, respectively. The five-year survival rate for Nevin stage I was 100%; for stage II, 60%; stage III, 33%; stage IV, 25% and for stage V, 0%. Radical surgery led to a better cumulative survival rate for Nevin stages III and IV (p < 0.01) than did simple cholecystectomy. Five Stage II cases were treated with simple cholecystectomy but two patients had early metastasis. Four stage III patients underwent simple cholecystectomy and three had metastasis within one year. CONCLUSIONS Based on these results, stage III and IV tumors require extended procedures for better survival. A high index of suspicion for the disease, careful intraoperative examination of the gallbladder specimen and earlier, more aggressive treatment may improve patient survival.

Hwang Kf

Papers

Choledochal cyst in adult

Thyroglossal duct cyst: an analysis of 92 cases.

Primary carcinoma of the gallbladder: results of surgery--a retrospective study.