Clinical Features and Surgical Management of Bile Duct Cyst in Adults

Objectives. Bile duct cyst (BDC) is a rare congenital biliary malformation with 20% of cases initially diagnosed during adulthood. Although the incidence of BDC in adults is increasing worldwide, the clinical features of adult BDC remain unclear. The present study was aimed at characterizing the demographic and clinical features of this rare disease. Methods. We constructed a retrospective database and analyzed records of 106 patients (mean age, 41.0±14.8 years; 18 men (17.0%)) with BDC treated at our institution from May 2012 to October 2018. Data collected included demographic characteristics, clinical manifestations, surgical patterns, and prognoses. We compared the characteristics of patients undergoing their primary BDC resection against those of patients undergoing reoperation. Risk factors for bile duct infection (BDI), a common complication of BDC, were identified using univariate and multivariate analyses. Results. Abdominal pain was the most common preoperative symptom, but 12 patients (11.3%) were asymptomatic. Ninety-nine patients underwent their primary BDC resection, and 7 patients received reoperation at our hospital. There was no significant difference in the postoperative complication rate between the two groups. Ninety-four patients were followed up for 37.8±23.8 months, and BDI occurred in 33 patients (35.1%). Hilar anastomosis was an independent risk factor for BDI (odds ratio=3.561; 95%confidence interval=1.101,11.517; and p=0.034). Conclusion. BDC was more frequent in women and abdominal pain was the most common preoperative symptom. The primary reason for reoperation was anastomotic stenosis. Reoperation had similar outcomes to primary resection and may be considered safe and acceptable if performed by a skillful surgeon. BDI was the most frequent postoperative complication with hilar anastomosis being the only independent risk factor. This highlights the importance of proper bile duct flow for surgical outcomes of BDC.