Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2016; 8(6): 427-435
Published online Jun 27, 2016. doi: 10.4240/wjgs.v8.i6.427
Impact of previous cyst-enterostomy on patients’ outcome following resection of bile duct cysts
Mehdi Ouaissi, Reza Kianmanesh, Emilia Ragot, Jacques Belghiti, Pietro Majno, Gennaro Nuzzo, Remi Dubois, Yann Revillon, Daniel Cherqui, Daniel Azoulay, Christian Letoublon, François-René Pruvot, François Paye, Patrick Rat, Karim Boudjema, Adeline Roux, Jean-Yves Mabrut, Jean-François Gigot
Mehdi Ouaissi, Department of General and Digestive Surgery, La Timone Hospital, 13009 Marseille, France
Reza Kianmanesh, Department of Digestive and Endocrine Surgery, Robert Debré Hospital, 51090 Reims, France
Emilia Ragot, Jacques Belghiti, Department of HPB Surgery, Beaujon Hospital, 92110 Clichy, France
Pietro Majno, Department of Digestive Surgery, Geneva University Hospital, 1205 Geneva, Switzerland
Gennaro Nuzzo, Department of HPB Surgery, Gemelli University Hospital, 00168 Roma, Italy
Remi Dubois, Department of Pediatric Surgery, Mother and Children Hospital, 69677 Bron, France
Yann Revillon, Department of Pediatric Digestive Surgery, Necker Hospital, 75175 Paris, France
Daniel Cherqui, Department of Digestive and HPB Surgery, Paul Brousse Hospital, 94800 Villejuif, France
Daniel Azoulay, Department of Digestive and HPB Surgery, Henri Mondor Hospital, 94000 Creteil, France
Christian Letoublon, Department of Digestive Surgery, Michallon Hospital, 38043 Grenoble, France
François-René Pruvot, Department of Digestive surgery and Transplantation, Claude Huriez Hospital, 59037 Lille, France
François Paye, Department of Digestive Surgery, , 75012 Paris, France
Patrick Rat, Department of Digestive Surgery, Dijon University Hospital, 21000 Dijon, France
Karim Boudjema, Department of HPB Surgery, Pontchaillou Hospital, 35033 Rennes, France
Adeline Roux, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, 69317 Lyon, France
Jean-Yves Mabrut, Department of Digestive Surgery and Hepatic Transplantation, La Croix-Rousse Hospital, 69317 Lyon, France
Jean-François Gigot, Department of Abdominal Surgery and Transplantation Division of Hepato-Biliary and Pancreatic Surgery Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
Author contributions: All the authors contribute to the manuscript.
Institutional review board statement: A multicenter retrospective study was conducted under the auspices of the Association Française de Chirurgie among their members, surgeons coming mainly from European countries. The patients’ medical records were included on a website database (http://www.chirurgie-viscerale.org) using an online computerized standardized questionnaire.
Informed consent statement: A multicenter retrospective study was conducted under the auspices of the Association Française de Chirurgie among their members, surgeons coming mainly from European countries.
Conflict-of-interest statement: All the authors have no conflicts of interest.
Data sharing statement: No data was created, so no data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jean-François Gigot, Professor, Department of Abdominal Surgery and Transplantation Division of Hepato-Biliary and Pancreatic Surgery Cliniques Universitaires Saint-Luc, Hippocrate Avenue, 1200 Brussels, Belgium. jean-francois.gigot@uclouvain.be
Telephone: +32-27-641505
Received: December 27, 2015
Peer-review started: January 11, 2016
First decision: February 2, 2016
Revised: March 21, 2016
Accepted: April 7, 2016
Article in press: April 8, 2016
Published online: June 27, 2016
Processing time: 176 Days and 15 Hours
Abstract

AIM: To analyze the impact of previous cyst-enterostomy of patients underwent congenital bile duct cysts (BDC) resection.

METHODS: A multicenter European retrospective study between 1974 and 2011 were conducted by the French Surgical Association. Only Todani subtypes I and IVb were included. Diagnostic imaging studies and operative and pathology reports underwent central revision. Patients with and without a previous history of cyst-enterostomy (CE) were compared.

RESULTS: Among 243 patients with Todani types I and IVb BDC, 16 had undergone previous CE (6.5%). Patients with a prior history of CE experienced a greater incidence of preoperative cholangitis (75% vs 22.9%, P < 0.0001), had more complicated presentations (75% vs 40.5%, P = 0.007), and were more likely to have synchronous biliary cancer (31.3% vs 6.2%, P = 0.004) than patients without a prior CE. Overall morbidity (75% vs 33.5%; P < 0.0008), severe complications (43.8% vs 11.9%; P = 0.0026) and reoperation rates (37.5% vs 8.8%; P = 0.0032) were also significantly greater in patients with previous CE, and their Mayo Risk Score, during a median follow-up of 37.5 mo (range: 4-372 mo) indicated significantly more patients with fair and poor results (46.1% vs 15.6%; P = 0.0136).

CONCLUSION: This is the large series to show that previous CE is associated with poorer short- and long-term results after Todani types I and IVb BDC resection.

Keywords: Bile duct cyst; Congenital; Biliary disease; Cyst-enterostomy; Long-term outcome

Core tip: Previous cyst-enterostomy is associated with more severe clinical presentation, including increased incidence of synchronous cancer, as well as poorer short- and long-term results in patients undergoing operations for Todani types I and IVb bile duct cysts.