Surgery. 2025 Aug 2;186:109596. doi: 10.1016/j.surg.2025.109596. Online ahead of print.
ABSTRACT
BACKGROUND: Late postoperative complications of congenital biliary dilatation include intrahepatic bile duct stones, cholangitis, and cholangiocarcinoma. This study aimed to establish a preoperative classification system using intrahepatic bile duct morphology and evaluate its effectiveness in predicting postoperative complications.
METHODS: This retrospective study reviewed 196 patients who underwent radical congenital biliary dilatation surgery between 2003 and 2022. Patients were classified into 3 risk groups based on preoperative cholangiopancreatography findings of intrahepatic bile duct morphology: risk type-low, no intrahepatic bile duct dilatation; risk type-intermediate, intrahepatic bile duct dilatation without downstream bile duct stenosis, but including stenosis at the hilar region; risk type-high, intrahepatic bile duct dilatation with downstream bile duct stenosis, including stenosis at the hilar region and more peripherally than the secondary branches.
RESULTS: The incidence of intrahepatic bile duct stones was significantly higher in risk type-high (n = 9, 53%) (P < .001) compared with risk type-low (0%) and risk type-intermediate (n = 3, 2.8%). The incidence of cholangitis was significantly higher in risk type-high (n = 9, 53%) (P < .001) compared with risk type-low (n = 3, 4.3%) and risk type-intermediate (n = 3, 2.8%). No cases of cholangiocarcinoma were observed. Patients with risk type-high who did not improve with double-balloon endoscopic retrograde cholangiography required percutaneous transhepatic biliary drainage or hepatectomy.
CONCLUSIONS: Our newly proposed preoperative classification system is effective in predicting postoperative complications in congenital biliary dilatation patients. Patients classified as risk type-high require careful postoperative follow-up, particularly when intraoperative bile ductoplasty fails to relieve stenosis. Identifying high-risk cases preoperatively may help improve long-term surgical outcomes.
PMID:40753665 | DOI:10.1016/j.surg.2025.109596
