Choledochal cysts – state of the art


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Abstract

Introduction. Choledochal cyst is enlargement of the external bile duct system that can lead to liver dysfunction and biliary cirrhosis in childhood and malignant degeneration of the liver and bile ducts in adulthood. There are many theories explaining the origin of the common bile duct cyst. However, none of them can explain the formation of all five different types. Most of them are congenital. However, some of them may be aquired. The theory of a long common biliopancreatic canal has become widespread and is still used to explain the formation of this type of cystic anomalies. If the common canal is long and its part is not surrounded by the sphincter of Oddi, the secret of the pancreas begins to be thrown into the choledochus. Proteolytic enzymes from the pancreas are quite active and can damage the epithelium and the wall of the bile ducts, which leads to their weakness and, as a result, dilatation of the choledochus. Ultrasound examination is the initial and main method for diagnosing choledochal cysts. In some cases, there is a need for endoscopic or magnetic resonance retrograde cholangiopancreatography, intraoperative cholangiography. Removal of the cyst and anastomosis of the common hepatic duct with the lumen of the jejunum or duodenum, performed through the subcostal approach, are standard procedures for the treatment of patients with a choledochal cyst. The advent of laparoscopy and the accumulation of experience in performing complex surgical interventions introduced a minimally invasive approach for the production of laparoscopic biliodigestive anastomoses. Intra- and postoperative complications include damage to the structures of the hepatic hilum, torsion of the abduction loop, incompetence and stricture of biliodigestive anastomosis, cholangitis, stone formation, adhesive intestinal obstruction, and malignancy of the cyst remnants.

Conclusion. This literature review has demonstrated modern views on the origin, etiology, diagnosis and treatment of choledochal cysts. The scientific work discussed the versatile technical aspects of the surgical treatment of choledochal cysts in children and assessed its safety and effectiveness.

About the authors

Thanh Liem Nguyen

Vinmec Research Institute of Stem Cell and Gene Technology

Email: fake@neicon.ru

Hanoi

Viet Nam

V. S. Cheremnov

Ivano-MMatrenensky Municipal Pediatric Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0001-6135-4054

Irkutsk, 664009, Russian Federation

Russian Federation

Yu. A. Kozlov

Ivano-MMatrenensky Municipal Pediatric Clinical Hospital; Irkutsk State Medical Academy of Continuing Education; Irkutsk State Medical University

Author for correspondence.
Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-2313-897X

Yury А. Kozlov, MD, head of surgical department for newborns; professor at chair of pediatric surgery; professor

Irkutsk, 664009, Russian Federation

Irkutsk, 664049, Russian Federation

Irkutsk, 664003, Russian Federation

Russian Federation

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