CHOLEDOCAL DISEASE MANAGEMENT: TEN YEARS INSTITUTIONAL EXPERIENCE

Document Type : Original Article

Authors

Department of HBP & Liver Transplantation Surgery, National Liver Institute, Menoufiya University, Egypt

Abstract

Background: Choledocal cysts are congenital anomalies of the bile ducts. 60% of patients are diagnosed 
during first decade of life; about 20% go undiagnosed until adulthood.
Patients and Methods: seventy patients with CC disease had been managed between 2001 and 2011 at 
National Liver Institute, Menoufiya University, Egypt. Retrospective analysis of their records performed to 
evaluate types, frequency, presentation, management and outcome of choledocal disease.
Results: Pediatrics (< 2years) were 30 patients (43%), Pediatrics (> 2 years) were 16 patients (23%), & adults 
were 24 patient (34%). Type I was recorded in 55 cases (79%), type II in 3 cases (4%), type III in 2 cases (3%), 
type IV in 3 cases (4%) and type V in 7 cases (10%). Complete cyst excision with HJ had been performed in 
82.5%, excision with primary closure of CBD in 4%, left hepatectomy in one case, right hepatectomy in 2 cases 
and non-operative management in 6 cases (8.5%). Postoperative bile leak occurred in 4%, biliary stricture in 
7% with intrahepatic stones in 2.4%. The overall mortality was 8.5% and all were from the pediatric group.
Conclusion: Choledocal disease requires proper diagnosis and treatment to address associated symptoms, 
risk of malignancy, and disease progression. The presentation of CC varies between different age groups. 
MRCP is mandatory and could be sufficient in the diagnosis. The majority of cases of biliary cysts (type I and 
IVA) can be treated effectively with cyst resection and biliary reconstruction.

Keywords

The Egyptian Journal of Surgery
Volume 32, Issue 4
October 2013
Pages 248-255

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