Abstract
Background: Postoperative bile duct stones, including intrahepatic bile duct (IHD) stones and remnant distal common bile duct (remnant intrapancreatic common bile duct, RIPD) or common channel duct (CCD) stones, cause long-term complications following choledochal cyst excision. We aimed to retrospectively review occurrence, associated factors, and treatment of postoperative bile duct stones.
Methods: Records of 457 pediatric patients who underwent choledochal cyst excision at Asan Medical Center (1992-2021) were retrospectively reviewed. Data on cholelithiasis, operation, and outcomes were analyzed.
Results: Overall, 457 pediatric patients underwent choledochal cyst excision, with 21 developing intrahepatic duct (IHD) stones, primarily associated with Todani type IVa cysts, especially Tsuchida types 2 or 3, which are often linked to IHD dilation and upstream stenosis. Patients with RIPD/CCD stones were all identified with complicated Komi types, and the impact of pancreas divisum itself was unclear. Early surgery even before six months of age is associated with improved prognosis regarding the occurrence of IHD stones, but not related with RIPD/CCD stones. Early surgery even before six months of age is associated with improved prognosis regarding the occurrence of IHD stones, but not related with RIPD/CCD stones.
Conclusions: This is the largest retrospective study comprising 21 IHD and 18 RIPD/CCD stones from 457 pediatric patients with choledochal cysts and including 21 cases of IHD stones and 18 cases of RIPD/CCD stones as well as their clinical and treatment outcomes to date in this aspect. Our findings suggest that a more systematic and long-term follow-up is needed for patients with choledochal cysts CC postoperatively.