Abstract
Total cyst excision (extrahepatic bile duct resection including cholecystectomy) with biliary tract reconstruction is regarded as the standard surgical procedure for congenital choledochal cyst. Most congenital choledochal cysts accompany with pancreato-biliary maljunction (PBM), which causes varied pathologies such as biliary tract cancer, cholangitis, and pancreatitis. Carcinoma arises also from the intrahepatic bile duct and the pancreatic duct even after total cyst excision.
When relative stenosis occurs in the hepatic duct near the hepatic hilum, it is necessary to extend incision to the wall of the left and right at the hepatic duct branch level, creating a large anastomotic opening. There is no consensus regarding whether or not hepatectomy should be considered at the primary surgery for congenital choledochal cysts, particularly in children. The risks have been also noted on cancer arising from the residual bile duct in the pancreas, pancreatitis, and pancreatic stone. It is necessary to resect the distal end of the common bile duct near the junction with the pancreatic duct so as not to remain the intrapancreatic bile duct.
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Koshinaga, T. (2018). Standard Surgical Procedure for CBD. In: Kamisawa, T., Ando, H. (eds) Pancreaticobiliary Maljunction and Congenital Biliary Dilatation. Springer, Singapore. https://doi.org/10.1007/978-981-10-8654-0_23
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DOI: https://doi.org/10.1007/978-981-10-8654-0_23
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