J.Jpn. Surg. Soc.. 97(8): 618-625, 1996

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Feature topic

SURGICAL STRATEGY FOR THE TREATMENT OF CONGENITAL BILIARY DILATATION BASED ON THE LOCATION OF INTRAHEPATIC BILE DUCT DILATATION

Congenital biliary dilatation used to be regarded as having a good prognosis. However, some recent long-term follow-up studies have shown there to be quite a high incidence of postoperative intrahepatic bile duct (IHBD) stone formation. In most of the cases in whom IHBD stones form, the IHBD were found to be dilated as the tirne of initial surgery. Therefore, preoperative evaluation of IHBD dilatatlon uslng various imaging studies is extremely important. Surgically, in cases involving stricutre of the common hepatic duct (CHD) with dilatation above the stricture, resection of the stricture and a wide hepaticointestinal anastomosis are strongly recommended. In cases where there is a stricuture of the CHD or of the first branch of the IHBD, a reconstructive technique should be applied to dilate the stricture. Patients who have a stricuture and cystic dilatation of the IHBD above the second branch should be carefully followed-up postoperatively. Partial liver resection to remove the cyst may be required at the time of initial operation or at a later stage.

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