Surgical management of choledochal cysts in adults; Our experience.
Konjenital koledok kistlerinde cerrahi tedavi sonuçlarımız
Keywords:
Choledochal cyst, Hepaticojejunostomy, Cholangiocarcinoma, jaundiceAbstract
Choledochal cysts are the name given to the congenital cystic dilatation of the intrahepatic and/or extrahepatic bile ducts. It is most commonly observed in childhood ages but there are cases diagnosed in adulthood. They are precancerous lesions and should be resected when diagnosed. The aim of this study is to present the results of the patients who underwent surgical therapy due to choledochal cyst.
This study retrospectively included adult patients who were diagnosed with choledochal cyst between January 2015 and December 2019. In addition to demographic data such as age and gender, the operative and postoperative morbidity and mortality rates were documented.
The study included nine patients who underwent surgery due to a choledochal cyst. Of nine patients, three (33%) were male and six (66%) were female. The general mean age of the patients was 42.4 while the mean age of male patients was 56.5 and female patients was 35.5. The complaints were jaundice in three patients (33%), acute pancreatitis in two patients (22%), biliary colic abdominal pain in two patients (22%), sepsis in one patient (11%), and suspected malignity in one patient (11%). Type 1 choledochal cyst was detected in all cases. In all patients included in the study, the external bile ducts including the intrapancreatic part were resected by incising the choledochal dilatation from the endpoint. The surgical procedure was performed laparoscopically in two cases (22%). A biliary fistula that regressed with medical treatment was detected in postoperative one patient (11%). A postoperative pancreas fistula was not detected in any patient. Margin positive adenocarcinoma was observed in the choledochal incisions of one patient who underwent laparoscopic surgery. The patient was taken to re-exploration and conventional pancreaticoduodenectomy was performed.
Choledochal cysts detected in older ages and male patients have a greater risk of malignity. Therefore, complete resection of bile ducts is necessary. The intraoperative frozen examination should be kept in mind as it protects patients from the second operation.
ÖZET
Koledok kistleri, safra yollarının intrahepatik ve/veya ekstrahepatik safra yollarının konjenital kistik dilatasyonuna verilen isimdir. En sık çocukluk yaş grubunda saptanmakla birlikte erişkin döneminde de tanı konulan vakalar bulunmaktadır. Prekanseröz lezyonlardır ve tanı konulduğunda rezeke edilmelidir. Bu makalemizde koledok kisti nedeniyle cerrahi tedavi uygulanan hastalarımızdaki sonuçlarımızı sunmayı amaçladık.
Çalışmaya Ocak 2015 ile Aralık 2019 yılları arasında koledok kisti tanısı konulan erişkin yaş grubundaki hastalar retrospektif olarak dahil edilmiştir. Yaş, cinsiyet gibi demografik verilerinin yanı sıra operatif ve postoperatif morbidite ve mortalite oranları dokümante edildi.
Çalışmamıza koledok kisti tanısıyla cerrahi uygulanmış 9 hasta dahil edildi. 9 hastanın 3âü (%33) erkek iken 6âsi (%66) kadın cinsiyet idi. Hastaların genel yaş ortalaması 42,4 yıl iken erkeklerde ortalama yaş 56,6 yıl, kadınlarda ise 35,3 yıl olarak saptanmıştır. Başvuru şikâyeti 3 (%33) hastada sarılık, 2 (%22) hastada akut pankreatit, 2 (%22) hastada biliyer kolik tarzda karın ağrısı, 1 (%11) hasta sepsis ve 1 (%11) hastada malignite şüphesidir. Olguların tümünde tip 1 koledok kisti saptanmıştır. Çalışmaya alınan tüm hastada koledok dilatasyonun bitiş yerinden kesilerek intrapankreatik kısmında dahil olduğu dış safra yolları rezeksiyonu uygulanmıştır. 2 olguda (%22) cerrahi prosedür laparoskopik olarak uygulanmıştır. Postoperatif 1 (%11) hastada medikal tedavi ile gerileyen safra fistülü saptandı. Postoperatif pankreas fistülü hiçbir hastada saptanmadı. Laparoskopik cerrahi uygulanan 1 hastada koledok kesitlerinde marjın pozitif adenokarsinom saptandı. Hasta re-eksplorasyona alınarak konvansiyonel pankreatikoduodenektomi uygulandı.
İleri yaş ve erkek hastada saptanan koledok kistleri yüksek malignite riski taşımaktadır. Bu nedenle safra yollarının komplet rezeksiyonu gereklidir. İntraoperatif frozen incelemesi hastaları ikinci ameliyattan koruması nedeniyle akılda tutulmalıdır.
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