Abstract
Purpose
Pancreatitis has been reported long after total choledochal cyst excision. The aim of this study was to determine if the disease process of postoperative pancreatitis differs between a primary and secondary cyst excision in a long-term follow-up.
Methods
Among 53 postoperative patients who underwent a total cyst excision and were followed up, 44 patients underwent a primary cyst excision (primary excision group), while 9 patients underwent a secondary cyst excision after a previous cyst-duodenostomy for internal drainage (secondary excision group). The long-term clinical course, including the pancreatographic findings after a total cyst excision, was compared.
Results
In the primary excision group, six patients had mild pancreatitis. Endoscopic retrograde pancreatography demonstrated ductal dilatation that was limited to the common channel in two patients, concurrent with the ventral duct in three, and extended the duct of Santorini in three. Conservative treatments were carried out in three patients, and endoscopic irrigation in one patient with protein plugs in the ventral duct. A resection of the choledochal remnant in the pancreas was performed in two patients with choledochal remnant-associated pancreatitis. From the secondary excision group, 5 of the 9 patients had chronic pancreatitis. Endoscopic retrograde pancreatography showed entire pancreatic ductal dilatation. Two of these patients underwent duodenal papilloplasty at the same time as secondary surgery; however, the disease progressively worsened.
Conclusion
In patients undergoing a secondary total excision after internal drainage, it is difficult to half the ongoing aggravating process in pancreatitis.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
T Koshinaga M Fukuzawa (2000) ArticleTitlePancreatic ductal morphological pattern and dilatation in postoperative abdominal pain in patients with congenital choledochal cyst: an analysis of postoperative pancreatograms Scand J Gastroenterol 35 1324–9 Occurrence Handle11199375 Occurrence Handle1:STN:280:DC%2BD3M7nslGltw%3D%3D Occurrence Handle10.1080/003655200453700
H Komuro SI Makino Y Yasuda T Ishibashi K Tahara H Nagai (2001) ArticleTitlePancreatic complications in choledochal cyst and their surgical outcomes World J Surg 25 1519–23 Occurrence Handle11775184 Occurrence Handle1:STN:280:DC%2BD38%2FkvVWjtQ%3D%3D
K Nakano A Mizuta S Oohashi S Kuroki K Yamaguchi M Tanaka et al. (2003) ArticleTitleProtein stone formation in an intrapancreatic remnant cyst after resection of a choledochal cyst Pancreas 26 405–7 Occurrence Handle12717276 Occurrence Handle10.1097/00006676-200305000-00017
N Komi H Takehara K Kunitomo Y Miyoshi T Yagi (1992) ArticleTitleDoes the type of anomalous arrangement of pancreaticobiliary ducts influence the surgery and prognosis of choledochal cyst? J Pediatr Surg 27 728–31 Occurrence Handle1306647 Occurrence Handle1:STN:280:By2A28vnslQ%3D
M Sunamura L Lozonschi K Takeda M Kobari S Matsuno (1998) ArticleTitleCriteria for diagnosis of acute pancreatitis in Japan and clinical implications Pancreas 16 243–9 Occurrence Handle9548662 Occurrence Handle1:STN:280:DyaK1c3gvVCnsQ%3D%3D Occurrence Handle10.1097/00006676-199804000-00007
T Honma (1998) ArticleTitleCriteria for pancreatic disease diagnosis in Japan: diagnostic criteria for chronic pancreatitis Pancreas 16 250–4 Occurrence Handle10.1159/000014341
CS Pitchumoni (2001) ArticleTitlePathogenesis of alcohol-induced chronic pancreatitis: facts, perceptions, and misperceptions Surg Clin North Am 81 379–90 Occurrence Handle11392424 Occurrence Handle1:STN:280:DC%2BD3MzhvFaguw%3D%3D Occurrence Handle10.1016/S0039-6109(05)70125-0
T Furui S Kondoh T Harada K Takeuchi K Shiraishi S Kaino et al. (2000) ArticleTitleCalcium concentration and artificial precipitates in human pancreatic juice Pancreas 21 257–61 Occurrence Handle11039469 Occurrence Handle1:STN:280:DC%2BD3cvovVGjuw%3D%3D Occurrence Handle10.1097/00006676-200010000-00006
K Kaneko H Ando T Ito Y Watanabe T Seo T Harada et al. (1997) ArticleTitleProtein plugs cause symptoms in patients which choledochal cysts Am J Gastroenterol 92 1018–21 Occurrence Handle9177522 Occurrence Handle1:STN:280:ByiA38%2FmslU%3D
JZ Jona DP Babbitt RJ Starshak AJ LaPorta M Glicklich RD Cohen (1979) ArticleTitleAnatomic observations and etiologic and surgical considerations in choledochal cyst J Pediatr Surg 14 315–20 Occurrence Handle480094 Occurrence Handle1:STN:280:Bi%2BD3cflvVM%3D
RM Filler G Stringel (1980) ArticleTitleTreatment of choledochal cyst by excision J Pediatr Surg 15 437–42 Occurrence Handle7411354 Occurrence Handle1:STN:280:Bi6D3cbgsVA%3D
E Moreno Gonzalez I Gracia Garcia M Hidalgo Pascual J Calleja Kempin G Garcia Blanch M Gomez Gutierrez et al. (1989) ArticleTitleCholedochal cyst resection and reconstruction by biliary-jejuno-duodenal diversion World J Surg 13 232–7 Occurrence Handle2728469 Occurrence Handle1:STN:280:BiaB28fot1I%3D Occurrence Handle10.1007/BF01658409
H Ando K Kaneko T Ito Y Watanabe T Seo T Harada et al. (1996) ArticleTitleComplete excision of the intrapancreatic portion of choledochal cysts J Am Coll Surg 183 317–21 Occurrence Handle8843259 Occurrence Handle1:STN:280:ByiD3c%2FhtFI%3D
K Chijiiwa (1993) ArticleTitleHazard and outcome of retreated choledochal cyst patients Int Surg 78 204–7 Occurrence Handle8276541 Occurrence Handle1:STN:280:ByuC3c3ptVM%3D
T Todani Y Watanabe A Toki N Urushihara Y Sato (1988) ArticleTitleReoperation for congenital choledochal cyst Ann Surg 207 142–7 Occurrence Handle3341813 Occurrence Handle1:STN:280:BieC3szgs1U%3D
K Kaneo H Ando Y Watanabe T Seo T Harada F Ito et al. (1999) ArticleTitleSecondary excision of choledochal cysts after previous cyst-enterostomies Hepatogastroenterology 46 2772–5
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Koshinaga, T., Wakabayashi, K., Inoue, M. et al. Pancreatitis After a Primary and Secondary Excision of Congenital Choledochal Cysts. Surg Today 36, 686–691 (2006). https://doi.org/10.1007/s00595-006-3237-2
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00595-006-3237-2