Surgical management and long-term follow-up of patients with choledochal cysts.

The medical records of 46 patients treated for choledochal cysts at Kyushu University from 1965 to 1990 were reviewed, and long-term follow-up results were evaluated based on the type of cyst and on the choice of surgical procedure. Of 46 patients, 41 (89%) were female and 5 (11%) were male, with a mean age of 24 years at the time of the initial operation. Seventy-eight percent of patients presented with an abdominal pain, 43% with jaundice, and 33% with an abdominal mass. Only seven patients (15%) presented with the classic triad. According to the Todani classification system, 26 patients (57%) had type I cysts, 2 (4%) had type II, and 18 (39%) had type IV. Four patients (9%) had biliary tract carcinoma. At the time of the initial operation, the major associated diseases were cholangitis in 15% and choledocholithiasis in 26% of cases. In 24 patients who had undergone previous cyst enterostomy, cholangitis developed in 88%, choledocholithiasis in 25%, and hepatolithiasis in 33% of patients, indicating a high complication rate after cyst enterostomy. Seventy percent of these patients needed reoperation. In contrast, cyst excision with Roux-en-Y hepaticojejunostomy gave excellent long-term results. Thus, cyst excision with hepaticojejunostomy is the definitive treatment of choice for type I and IV choledochal cysts.