Surgical treatment of congenital cystic dilation of the biliary tract.

Cystic dilation of the biliary tract in 38 Vietnamese children is reported. Most had symptoms and signs of cholangitis and biliary obstruction. The surgical management is discussed, and for choledochal cyst resection of the cyst with hepaticojejunostomy Roux-en-Y is recommended. Postoperative cholangitis occurred in 16% of the children. The overall mortality was 18% after a median follow-up time of 28 months. Cystic dilation of the biliary tract is suggested to be a congenital entity, resulting from two pathogenetic factors--an unexplained structural anomaly of the biliary duct wall and an abnormality of the choledochopancreatic junction. A new classification is proposed, based on previous reports and the present study: A1) choledochal cyst, A2) choledochal diverticulum, A3) choledochocele, B) biliary cyst of the main hepatic ducts, C) intrahepatic and extrahepatic cyst, and D) Caroli's disease (intrahepatic biliary cysts).