Surgical Management of Adult Choledochal Cysts
Thawatchai Akaraviputh, MD*, Wiroon Boonnuch, MD*, Prasit Watanapa, MD, PhD, FRCS, FACS*, Narong Lert-akayamanee, MD, FRCS*, Darin Lohsiriwat, MD*
Affiliation : * Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University
Objectives : Results of the surgical management of 17 choledochal cysts in adults at the Department of
Surgery, Siriraj Hospital, Mahidol University, are presented.
Materials and Methods : All the patients who underwent diagnosis and were surgically managed during the
period between October 1990 and January 1999 were analyzed retrospectively. Cysts were classified
anatomically according to the descriptions of Todani et al. The authors assessed the clinical features,
operative procedure and outcome of the patients.
Results : There were 15 females and 2 males, with ages ranging from 16-45 years. Only 2 patients (11.8%) had
the clinical triad: jaundice, abdominal pain and mass. Clinical pancreatitis was presented in 3 patients
(17.6%). There were 10 type I (58.8%), 6 type IVa (35.3%) and one type V (5.9%) according to Todani’s
classification. Cholangiocarcinoma was found in one patient (5.9%). Extrahepatic cyst excision with a
Roux-en-Y hepatico-jejunostomy was performed on 16 patients with type I or IVa cysts (94.1%). There were
no surgical deaths or complications. Ten survivors are well. The authors lost contact with 6 patients during
follow-up (35.2%). The median follow up was 3.2 years. The patient with cholangiocarcinoma died 2 years
after treatment.
Conclusion : This experience recommends total extra-hepatic cyst excision with Roux-en-Y hepaticojejunos-
tomy as the treatment of choice for adult choledochal cyst type I and IV to eliminate the risk of recurrent
cholangitis and malignancy.
Keywords : Adult choledochal cyst, Surgical management
