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Comparative analysis of different hepatico-jejunostomy techniques for treating adult type I choledochal cyst
OBJECTIVE: To compare Roux-en-Y hepatico-jejunostomy with complete resection of the cyst or incomplete resection with 1-cm remnant proximal cyst wall in treating adult type I choledochal cyst (CC). METHODS: The medical records of 267 adult patients with type I CC from January 1998 to December 2015 w...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806402/ https://www.ncbi.nlm.nih.gov/pubmed/29479444 http://dx.doi.org/10.1093/gastro/gox025 |
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author | Ma, Wenjie Tan, Yongqiong Shrestha, Anuj Li, Fuyu Zhou, Rongxing Wang, Junke Hu, Haijie Yang, Qin |
author_facet | Ma, Wenjie Tan, Yongqiong Shrestha, Anuj Li, Fuyu Zhou, Rongxing Wang, Junke Hu, Haijie Yang, Qin |
author_sort | Ma, Wenjie |
collection | PubMed |
description | OBJECTIVE: To compare Roux-en-Y hepatico-jejunostomy with complete resection of the cyst or incomplete resection with 1-cm remnant proximal cyst wall in treating adult type I choledochal cyst (CC). METHODS: The medical records of 267 adult patients with type I CC from January 1998 to December 2015 were reviewed retrospectively. Among them, 171 underwent Roux-en-Y hepatico-jejunostomy with complete resection (PBD 0-cm group) and 96 underwent Roux-en-Y hepatico-jejunostomy with 1-cm proximal cyst wall left (PBD 1-cm group). The short- and long-term post-operative complications were compared between the two groups. RESULTS: No significant difference was observed in operative time or anastomotic diameter between the two groups. The incidence of perioperative complications was significantly higher in the PBD 1-cm group than that in the PBD 0-cm group (28.1% vs 14.0%, p=0.005), especially post-operative cholangitis (7.3% vs 1.2%, p=0.021). The incidence of long-term post-operative complications was not significantly different, including anastomotic stricture, reflux cholangitis, intra-hepatic bile duct stones and bile leak (all p >0.05). Post-operative intra-pancreatic biliary malignancy occurred in one patient in the PBD 0-cm group at 25 months and one patient in the PBD 1-cm group at 5 month, respectively. Anatomical site malignancy was observed in one patient in the PBD 1-cm group at 10 months. CONCLUSION: Ease of performing anastomosis does not justify retaining a segment of choledochal cyst in type I CC due to its higher risk of post-operative complication and malignancy. A complete excision of the CC with anastomosis to the healthy proximal bile duct is necessary in treatment of type I CC. |
format | Online Article Text |
id | pubmed-5806402 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-58064022018-02-23 Comparative analysis of different hepatico-jejunostomy techniques for treating adult type I choledochal cyst Ma, Wenjie Tan, Yongqiong Shrestha, Anuj Li, Fuyu Zhou, Rongxing Wang, Junke Hu, Haijie Yang, Qin Gastroenterol Rep (Oxf) Original Articles OBJECTIVE: To compare Roux-en-Y hepatico-jejunostomy with complete resection of the cyst or incomplete resection with 1-cm remnant proximal cyst wall in treating adult type I choledochal cyst (CC). METHODS: The medical records of 267 adult patients with type I CC from January 1998 to December 2015 were reviewed retrospectively. Among them, 171 underwent Roux-en-Y hepatico-jejunostomy with complete resection (PBD 0-cm group) and 96 underwent Roux-en-Y hepatico-jejunostomy with 1-cm proximal cyst wall left (PBD 1-cm group). The short- and long-term post-operative complications were compared between the two groups. RESULTS: No significant difference was observed in operative time or anastomotic diameter between the two groups. The incidence of perioperative complications was significantly higher in the PBD 1-cm group than that in the PBD 0-cm group (28.1% vs 14.0%, p=0.005), especially post-operative cholangitis (7.3% vs 1.2%, p=0.021). The incidence of long-term post-operative complications was not significantly different, including anastomotic stricture, reflux cholangitis, intra-hepatic bile duct stones and bile leak (all p >0.05). Post-operative intra-pancreatic biliary malignancy occurred in one patient in the PBD 0-cm group at 25 months and one patient in the PBD 1-cm group at 5 month, respectively. Anatomical site malignancy was observed in one patient in the PBD 1-cm group at 10 months. CONCLUSION: Ease of performing anastomosis does not justify retaining a segment of choledochal cyst in type I CC due to its higher risk of post-operative complication and malignancy. A complete excision of the CC with anastomosis to the healthy proximal bile duct is necessary in treatment of type I CC. Oxford University Press 2018-02 2017-07-02 /pmc/articles/PMC5806402/ /pubmed/29479444 http://dx.doi.org/10.1093/gastro/gox025 Text en Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-Sen University http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Ma, Wenjie Tan, Yongqiong Shrestha, Anuj Li, Fuyu Zhou, Rongxing Wang, Junke Hu, Haijie Yang, Qin Comparative analysis of different hepatico-jejunostomy techniques for treating adult type I choledochal cyst |
title | Comparative analysis of different hepatico-jejunostomy techniques for treating adult type I choledochal cyst |
title_full | Comparative analysis of different hepatico-jejunostomy techniques for treating adult type I choledochal cyst |
title_fullStr | Comparative analysis of different hepatico-jejunostomy techniques for treating adult type I choledochal cyst |
title_full_unstemmed | Comparative analysis of different hepatico-jejunostomy techniques for treating adult type I choledochal cyst |
title_short | Comparative analysis of different hepatico-jejunostomy techniques for treating adult type I choledochal cyst |
title_sort | comparative analysis of different hepatico-jejunostomy techniques for treating adult type i choledochal cyst |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806402/ https://www.ncbi.nlm.nih.gov/pubmed/29479444 http://dx.doi.org/10.1093/gastro/gox025 |
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