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The distal classification and management of choledochal cyst in adults: Based on the relation between cyst and pancreatic duct.

Abstract Todani classification is extensively used to guide the surgical strategy of choledochal cysts, but no systematic investigations on the distal management of intrapancreatic choledochal cysts have been conducted. This study reports the distal classification and management of choledochal cysts in adults based on the relation between the cyst and pancreatic duct. Patients with choledochal cyst who underwent operation, including distal management, in our department from January 2009 to December 2014 were retrospectively reviewed. Patients presenting symptoms, coexisting diseases, surgical treatment, perioperative complications, and long-term follow-up according to the distal classification of choledochal cyst were analyzed. A total of 54 patients with choledochal cyst were included in the present retrospective study. Based on the distal classification of choledochal cyst, 39 patients (72.22%) were type 1, 13 patients (24.07%) were type 2, and 2 patients (3.70%) were type 3. Thirty-nine type 1 patients and 10 type 2 patients underwent excision of intrapancreatic choledochal cyst or bile duct. Three type 2 patients received excision of distal cylindrical cyst and papilla, followed by pancreatic duct plasty with duodenum mucosa. One type 3 patient underwent endoscopic sphincteroplasty, and another type 3 patient underwent transduodenal sphincteroplasty. After the operation, 11 patients (20.37%, 11/54) had short-term perioperative complications. The long-term follow-up results showed that the satisfactory rate (excellent and good outcomes) was 95.83%. Current distal classification of choledochal cysts could provide a more targeted strategy for complete excision to eliminate potential dead space within the pancreas, protect the pancreatic duct, and prevent reoperation.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28328818
OWN - NLM
STAT- MEDLINE
DA  - 20170322
DCOM- 20170412
LR  - 20170412
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 12
DP  - 2017 Mar
TI  - The distal classification and management of choledochal cyst in adults: Based on 
      the relation between cyst and pancreatic duct.
PG  - e6350
LID - 10.1097/MD.0000000000006350 [doi]
AB  - Todani classification is extensively used to guide the surgical strategy of
      choledochal cysts, but no systematic investigations on the distal management of
      intrapancreatic choledochal cysts have been conducted. This study reports the
      distal classification and management of choledochal cysts in adults based on the 
      relation between the cyst and pancreatic duct. Patients with choledochal cyst who
      underwent operation, including distal management, in our department from January 
      2009 to December 2014 were retrospectively reviewed. Patients presenting
      symptoms, coexisting diseases, surgical treatment, perioperative complications,
      and long-term follow-up according to the distal classification of choledochal
      cyst were analyzed. A total of 54 patients with choledochal cyst were included in
      the present retrospective study. Based on the distal classification of
      choledochal cyst, 39 patients (72.22%) were type 1, 13 patients (24.07%) were
      type 2, and 2 patients (3.70%) were type 3. Thirty-nine type 1 patients and 10
      type 2 patients underwent excision of intrapancreatic choledochal cyst or bile
      duct. Three type 2 patients received excision of distal cylindrical cyst and
      papilla, followed by pancreatic duct plasty with duodenum mucosa. One type 3
      patient underwent endoscopic sphincteroplasty, and another type 3 patient
      underwent transduodenal sphincteroplasty. After the operation, 11 patients
      (20.37%, 11/54) had short-term perioperative complications. The long-term
      follow-up results showed that the satisfactory rate (excellent and good outcomes)
      was 95.83%. Current distal classification of choledochal cysts could provide a
      more targeted strategy for complete excision to eliminate potential dead space
      within the pancreas, protect the pancreatic duct, and prevent reoperation.
FAU - Liu, Yanfeng
AU  - Liu Y
AD  - aDepartment of Hepatobiliary Surgery, Qilu Hospital of Shandong University
      bDepartment of Surgery, Affiliated Hospital of Shandong University of Traditional
      Chinese Medicine, Jinan, Shandong, China.
FAU - Sun, Jingxian
AU  - Sun J
FAU - Guo, Sen
AU  - Guo S
FAU - Liu, Zengli
AU  - Liu Z
FAU - Zhu, Min
AU  - Zhu M
FAU - Zhang, Zong-Li
AU  - Zhang ZL
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Choledochal Cyst/*classification/*surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pancreatic Diseases/classification/surgery
MH  - Postoperative Complications/epidemiology
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC5371455
EDAT- 2017/03/23 06:00
MHDA- 2017/04/13 06:00
CRDT- 2017/03/23 06:00
AID - 10.1097/MD.0000000000006350 [doi]
AID - 00005792-201703240-00021 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Mar;96(12):e6350. doi: 10.1097/MD.0000000000006350.

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