Clinical Problems after Extrahepatic Bile Duct Excision and Reconstruction for Congenital Bile Duct Dilatation -Postoperative Cholangitis and Pancreatitis-

Tsukasa Azuma, Tatsuya Yoshikawa, Toshihide Imaizumi, Tatsuo Araida, Takehiro Ohta, Ken Takasaki

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

We investigated the clinical problems after extrahepatic bile duct excision and reconstruction for congenital bile duct dilatation with anomalous arrangement of the pancreaticobiliary ductal system. The subjects were 127 patients with non-cancerous Todani type I or IV-A congenital bile duct dilatation, who had undergone extrahepatic bile duct excision and reconstruction. The postoperative course was poor in 24 patients because of cholangitis or pancreatitis, and the reasons included residual bile duct stenosis in the portal region, severe dilatation and multiple stenosis of the bilateral intrahepatic bile ducts, stenosis of the hepaticojejunostomy, cholestasis in the jejunal loop used in biliary reconstruction, and poor drainage of pancreatic juice in pancreatic head. Accordingly, the following preventive measures should be taken: (1) The extrahepatic bile duct should be sufficiently resected so that there is no residual bile duct stenosis in the portal region or the dilated bile duct in the pancreas. (2) Hepatectomy or excision of the pancreatic head should be considered in patients with severe dilatation and multiple stenosis of the intrahepatic bile ducts, pancreatoliths which are difficult to be removed, or complex pancreatic duct anomalies.

Key words
congenital bile duct dilatation, anomalous arrangement of the pancreaticobiliary ductal system, extrahepatic bile duct excision and reconstruction

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
March 19, 1997

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