Hepatic lobectomy and mucosectomy of intrahepatic cyst for type IV-A choledochal cyst

ObjectiveExcision of extrahepatic cyst with wide biliary-enteric anastomosis is the treatment of choice in choledochal cyst. The diseased mucosa of the residual cyst may be the cause for postoperative complications. Mucosectomy of the cyst wall may prevent such complications in type IV-A choledochal cyst.Patients and MethodsFive cases (male:female, 3:2) of type IV-A choledochal cyst, aged between 15 and 120 months, are presented. The intrahepatic cyst was confined to only the left lobe in 1 patient and the left and part of the right lobe in 4 patients. Excision of the extrahepatic cyst, left hemihepatectomy, mucosectomy of the residual intrahepatic cyst wall, and wide hepaticojejunostomy were done.ResultsMedian hospital stay was 20 days. Postoperative biliary leak in 1 patient stopped spontaneously after 3 weeks. Postoperative MRCP (magnetic resonance cholangiopancreatography) scan in 1 patient showed shrinkage of intrahepatic residual cyst and good biliary drainage. Liver function tests at 3 months, 6 months, and at yearly intervals were within reference range in all patients. Cholangitis, hepatolithiasis, or malignancy was not noted in any of the patients. Median follow-up period was 36 months.ConclusionExcision of the diseased mucosa from residual intrahepatic cyst wall may prevent long-term complications in patients with type IV-A choledochal cyst.