Choledochal anomalies in adults: A 20-year single-center retrospective cohort experience in the Middle East
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Elsevier Ltd
Abstract
Background and study aims: Choledochal cysts are rare congenital cystic dilatations of the bile ducts that occur in fewer than 1% of individuals. The disease is common in East Asia, and most of the literature concerns those populations, but some data about Western populations have been published recently. Long-term reports about the disease in Middle Eastern populations, however, are currently lacking. We report a single-center 20-year experience in diagnosing and managing choledochal anomalies. Patients and methods: Participants were adult patients in whom choledochal cysts were diagnosed over a 20-year (2000–2019) period at a single tertiary academic care center. Clinical data, including radiologic imaging findings, were retrieved from the patients’ medical records. To describe the baseline characteristics of the population, we calculated descriptive statistics. Results: Choledochal anomalies were diagnosed in 19 adult patients, whose median age was 30 years (interquartile range [IQR], 23–67 years). Of the choledochal cysts 13 (68.4%) were classified as Todani type I, 4 (21.1%) as Todani type IV, and 3 (15.8%) as Todani type V (Caroli's disease). No patient had underlying chronic liver disease, and liver synthetic function was preserved in all. Eighteen patients (94.7%) underwent surgery: cyst excision with Roux-en-Y hepaticojejunostomy in 17 and liver transplantation in 1. All 18 survived surgery, and the median postoperative hospital stay was 11 days (IQR, 5–34 days). All 18 were alive 90 days after surgery, and the median follow-up period was 40 months (IQR, 12–140 months). Seven patients (36.8%) developed postoperative surgical complications; 2 patients required rehospitalization, and 1 required reoperation. Conclusion: This description of adults with choledochal cysts is the latest long-term report about this disease in the Middle East. In our 20-year experience, the disease characteristics in our patients were moderately consistent with those described previously. © 2022
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Anastomosis, Biliary tract surgical procedures, Choledochal cyst, Jaundice, Middle east, Obstructive, Roux-en-y, Adult, Aged, Humans, Middle aged, Retrospective studies, Young adult, Alkaline phosphatase, Antibiotic agent, Aspartate aminotransferase, Bilirubin, Ca 19-9 antigen, Contrast medium, Extended spectrum beta lactamase, Gamma glutamyltransferase, Human immunodeficiency virus antibody, Ursodeoxycholic acid, Abdominal pain, Abdominal radiography, Acute cholecystitis, Acute pancreatitis, Alkaline phosphatase blood level, Antibiotic prophylaxis, Antigen blood level, Antimicrobial therapy, Article, Aspartate aminotransferase blood level, Asymptomatic disease, Autosomal recessive disorder, Bile leakage, Bilirubin blood level, Blood culture, Caroli disease, Cholangitis, Cholecystectomy, Cholecystitis, Chronic liver disease, Clinical article, Clinical study, Cohort analysis, Common bile duct cyst, Computer assisted tomography, Conservative treatment, Descriptive research, Distant metastasis, Echinococcosis, Echography, Emergency ward, Endoscopic retrograde cholangiopancreatography, Extrahepatic bile duct, Female, Fluid resuscitation, Follow up, Frozen section, Gamma glutamyl transferase blood level, Hepatojejunostomy, Hospital discharge, Hospital readmission, Hospitalization, Human, Intensive care unit, International normalized ratio, Jejunal intussusception, Kidney cyst, Kidney function, Kidney polycystic disease, Laparotomy, Liver function, Liver transplantation, Magnetic resonance cholangiopancreatography, Male, Medical record, Obstructive jaundice, Pancreas adenocarcinoma, Patient history of cholecystectomy, Percutaneous drainage, Peroperative cholangiography, Platelet count, Pleura effusion, Portal hypertension, Postoperative complication, Postoperative period, Reoperation, Retrospective study, Roux y anastomosis, Sepsis, Surgical infection, Surgical patient, Tumor recurrence, University hospital