A Clinical Study on Surgical Treatment for Anomalous Arrangement of the Pancreaticobiliary Ductal System without Dilatation of the Common Bile Duct

Tsukasa Azuma, Fujio Hanyu, Mitsuji Nakamura, Toshihide Imaizumi, Tatsuya Yoshikawa, Tatsuo Araida, Ken Takasaki

Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical College

We studied surgical treatment for anomalous arrangement of the pancreaticobiliary ductal system without dilatation of the common bile duct in 18 of 38 patients. The remaining 20 patients were excluded from the study because of the complication of carcinoma (carcinoma of the gallbladder in all 20 patients). Extrahepatic bile duct excision and reconstruction of the bile duct was performed on 4 patients with pancreatitis or cholangitis due to the pancreaticobiliary anastomotic anomaly and cholecystectomy alone was performed on the remaining 14 patients. The resected gallbladders showed mucosal hyperplasia or metaplasia, while no such changes were seen in the bile duct mucosa in the 4 patients who received extrahepatic bile duct excision. The postoperative course of the 14 patients receiving cholecystectomy alone was followed with blood chemistry studies and imaging studies over an average period of 4 years and 5 months (with a range of 13 months to 9 years and 8 months). The postoperative course of all 14 patients was uneventful, and none of them had abnormalities due to remnant pancreaticobiliary anastomotic anomaly. Further prolonged follow-up is warranted in our series of patients, but these results suggest that cholecystectomy can be advocated in anomalous arrangement of the pancreaticobiliary ductal system without dilatation of the common bile duct, if pancreatitis or cholangitis due to the pancreaticobiliary anastomotic anomaly can be precluded.

Key words
anomalous arrangement of the pancreaticobiliary ductal system, common bile duct without dilatation, cholecystectomy, excision of the extrahepatic bile duct

Reprint requests
Tsukasa Azuma Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical College
8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JAPAN

Accepted
November 15, 1995

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