Congenital choledochal dilatation: Classification, clinical features, and long-term results

Choledochal cyst is generally accompanied by pancreatobiliary malunion. Pancreatic juice usually refluxes into the bile duct via the malunion, and bile juice occasionally regurgitates into the pancreatic duct. As a result, various pathological conditions occur in the biliary tract, pancreas, and liver. We have revised our classification of choledochal cyst on the basis of malunion. Abdominal mass, pain, and jaundice are regarded as the triad of choledochal cysts, but symptoms are quite non-specific. In neonates and infants less than 12 months of age, choledochal cyst is usually huge and no cylindrical dilatation is observed. Vomiting and jaundice with acholic stool are often observed. No hyperamylasemia is seen, despite the presence of a malunion. Whereas children over 13 months of age tend to show diffuse dilatation, and an abdominal mass is rarely palpable. Epigastralgia with hyperamylasemia, fever, vomiting, and slight jaundice are often observed. Cyst excision is the treatment of choice to prevent the development of ascending cholangitis and cancer in the cyst. Late complications of excisional surgery include recurrent cholangitis, pancreatitis, and rarely, biliary malignancy. These complications usually develop 5 years or more after initial surgery and become the object of reoperation. Complete removal of the extrahepatic bile duct from the hepatic hilum to the intrapancreatic duct and a hilar hepaticoenterostomy with wide anastomosis after ductoplasty, including the coexisting primary stricture, are essential at the primary surgery. Provided a large anastomosis, favorable results can be obtained with either duodenostomy or Roux-Y jejunostomy. Surgical enlargement of the hilar ducts and careful lifelong follow-up should be routine in all patients who have undergone cyst excision. When ductal stricture with intrahepatic gallstones is confirmed, reoperation at an early stage is indicated to obtain a good quality of life with short hospitalization.     

Forme fruste choledochal cyst

Four patients had the characteristic features of choledochal cyst except for the cystic component. All patients had stenosis of the distal common bile duct, a "long common channel" secondary to a proximal junction of the common bile and pancreatic ducts, cholecystitis and the classic pathological microscopic features of choledochal cyst in the wall of the common bile duct. Three children had coexisting intrahepatic duct cysts and/or stenosis and one had intrahepatic choledocholithiasis. The clinical presentations were cholangitis (2), pancreatitis (1) and biliary obstruction (1). In all cases the common bile duct was resected and biliary reconstruction was carried out by choledochojejunostomy (Roux-en-Y). Morbidity was minor except in one patient with ductal disease extending far into the intrahepatic ducts. This child developed an anastomotic stricture requiring revision of the anastomosis and long-term "U" tube stenting. Forme fruste choledochal cyst appears to be another variation in the spectrum of pancreaticobiliary malformations of choledochal cyst. Treatment is identical, that is, excision of all malformed ductal tissue.     

ERCP诊治成人原位肝移植术后胆道并发症的临床研究

目的 :回顾性分析和评价内镜逆行胰胆管造影(ERCP)在成人原位肝移植胆道并发症诊疗中的作用。方法:38例成人原位肝移植术后胆道并发症患者实施61次ERCP,根据ERCP结果实施内镜治疗。结果:60次ERCP成功,成功率为98.36%(60/61)。ERCP明确胆道并发症原因后实施内镜治疗。并发症发生的部位为:供体肝胆管、受体胆管、胆管吻合口及十二指肠乳头。其中单纯胆管炎性狭窄7例,胆管炎性狭窄伴肝内外胆管铸型、胆泥或胆石形成10例;单纯胆管吻合口狭窄3例,狭窄伴肝内外胆管铸型、胆泥或胆石形成2例;胆管吻合口瘘2例,供体胆管与受体胆管直径差异过大1例;受体胆管过长、扭曲3例,受体胆管轻度扩张1例;十二指肠乳头狭窄2例,Oddi括约肌功能失调3例;T管脱落1例;胆道出血1例;ERCP插管失败1例。该组供体肝胆管并发症发生率最高,为44.74%(17/38);其次为胆管吻合口并发症,为21.05%(8/38)。治疗方式:乳头括约肌切开(EST)24.59%(15/61),乳头柱状球囊扩张(EPBD)16.39%(10/61),EST+EPBD 13.12%(8/61),扩张器扩张胆管36.07%(22/61),鼻胆管引流(ENBD)52.46%(32/61),胆管支架引流(ERBD)32.79%(20/61),取胆管铸型、胆泥或结石19.67%(12/61),胆道冲洗24.59%(15/61)。结论:ERCP具有诊疗一体化优点,已成为成人原位肝移植术后胆道并发症微创治疗的主要方法和重要治疗手段。     

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尽可能彻底切除异常扩张的胆管并实现胆汁与胰液完全分流是目前先天性胆管扩张症手术治疗的主要目标,但胆肠吻合的质量对远期疗效有重要影响,需严格遵循胆道外科基本原则实施操作。胆肠吻合口狭窄是先天性胆管扩张症术后远期疗效不佳的最常见原因。大致可分为两种类型,一类为原行囊肿空肠吻合或囊肿部分切除、上段残留囊肿空肠吻合者,胆肠吻合口相对于明显膨大的囊肿残腔呈"相对性狭窄";另一类为通常意义的胆肠吻合口狭窄,与囊肿上切缘位置过高、原有肝门区胆管结构异常、肝内胆管囊肿未妥善处理、吻合操作欠妥等有一定关系。总结此类病人术后胆肠吻合口狭窄及结石再生的原因,对更合理地治疗先天性胆管扩张症确有现实意义。     

肝移植术后胆道并发症的内镜治疗

目的:探讨内镜下逆行胰胆管造影术(ERCP)在治疗肝移植术后胆道并发症方面的临床疗效.方法:回顾性分析2002年8月-2012年12月采用ERCP治疗8例肝移植术后胆道并发症患者的临床资料,其中胆道狭窄5例(吻合口狭窄4例,肝内型胆道狭窄1例),胆瘘1例,胆石和胆泥形成2例.8例患者共行ERCP治疗21次,对胆道狭窄患者行括约肌切开、胆管扩张、鼻胆管引流和内支架置放术等治疗;对胆瘘患者行鼻胆管引流及塑料内支架置放术等治疗;对结石患者行括约肌切开、鼻胆管冲洗引流术及取石网篮取石等治疗.结果:ERCP手术成功率为100％ (21/21);4例吻合口狭窄、1例胆瘘和2例结石患者均治愈,1例肝内型胆道狭窄治疗未成功,建议再次肝移植;术后胆道感染的发生率为14.3％(3/21),胰腺炎发生率为19.0％ (4/21),经对症治疗后均痊愈.结论:ERCP是治疗肝移植术后胆道并发症微创、安全和有效的方法.     

胆肠吻合术后再手术的原因及处理

目的 探讨胆肠吻合术后再手术的原因及处理方法。方法 回顾性分析1995年6月－1999年6月间28例胆肠吻合术后再手术的临床资料。结果 28例中,吻合口狭窄26例（92．8％）,伴左肝管狭窄9例,肿肝管狭窄3例,左右肝管狭窄5例。钡餐造影9例见胆管内返流,均为胆总管十二指肠吻合者。再手术方法：原吻合口切除再吻合3例,左肝外叶切除、肝门胆管整形与空肠Roux-en-Y吻合8例,左肝管、肝门胆管与空肠双口吻合2例,肝内胆管狭窄切开并整形后与空肠Roux-en-Y吻合15例。26例（92．8％）随访0．5－4年,仅1例（3．8％）间有轻度感染症状。结论 胆肠吻合口狭窄是再手术的根本原因,其次是术式选择不当、肝胆管狭窄未予解除及结石清除不彻底。再手术时应遵循清除结石、解除狭窄及通畅引流的原则,必要时结合肝段（叶）切除、吻合口支撑引流及术中、术后胆道镜处理。     

胆管空肠Roux—en—Y吻合术后再手术原因及对策

目的 探讨胆管空肠Roux-en-Y吻合术（胆肠R－Y吻合术）后再手术的原因及对策。方法 对我院1988年1月至1999年10月收治的20例胆肠R－Y吻合术后再手术病人的临床资料作回顾性分析。结果 再手术原因有：肝内胆管狭窄伴结石4例;肝门胆管狭窄伴结石6例;吻合口狭窄伴结石4例;单纯吻合口狭窄3例;反流性胆管炎2例;胆管末端漏斗综合征1例。再手术方式：吻合口切开整形并左肝外叶切除2例;肝门胆管切开整形,取尽结石后行高位胆管空肠再吻合7例;原吻合口扩大整形,取石8例;吻合口切开整形,桥袢延长并人工空肠套叠1例;经空肠盲袢取石,吻合口扩大成形1例;吻合口切除,胆肠端侧吻合,胆总管盲端 关闭1例。全组病人经治疗后均痊愈出院。结论 胆肠R－Y吻合术及以后的再手术均应以取尽结石,纠正狭窄,去除病灶,通畅引流为原则,方可提高疗效,减少再手术率。     

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先天性胆管扩张症是一种先天性的胆管发育异常,多在儿童时发病,手术是主要治疗措施。目前手术多采用囊肿切除、肝管空肠吻合术。术后远期并发症包括胆道感染、结石、吻合口狭窄及癌变。临床上应着重预防并发症的发生,出现并发症常需再次手术治疗。     

Ultrasonographic findings and management of intrahepatic biliary tract abnormalities after portoenterostomy

Ultrasonographic examinations was made in 24 children who had undergone a portenterostomy to correct extrahepatic biliary atresia. Abnormalities were observed in six patients. These were the result of ongoing inflammatory reactions because all had been suffering from cholangitis after surgery, and the size of the biliary tract structure changed in accordance with the occurrence and subsidence of the cholangitis. Ultrasonographic examination showed dilation of the intrahepatic bile duct in one patient and cystic lesions in five patients. Treatment included percutaneous transhepatic bile drainage for dilated bile ducts, alcohol injections for intrahepatic cysts, and reoperation for cysts in the porta hepatis. Treatment was not required for cysts in controllable cholangitis. The results of these approaches were excellent, indicating that they were of benefit in treatment intrahepatic abnormalities occurring after portoenterostomy.     

A study on postoperative bile duct stricture with intrahepatic stones

From January 1976 through December 1988 we encountered ninety nine cases of intrahepatic stones. Eight of them were complicated with postoperative bile duct strictures which were formed on cholangiojejunostomy in 5 cases, cholangioduodenostomy, hepatic hilum and common hepatic duct in 1 case, respectively. Six cases of them are anastomotic strictures. The stones were mainly composed of bilirubin calcium. We guessed that the bile duct stricture resulted from cholangiojejunostomy without Roux-en-Y in 1 case and anastomotic insufficiency in 5 cases. Intrahepatic stones were removed by percutaneous transhepatic cholangioscopy (PTCS), and the treatment for the stricture was cholangiojejunostomy in 1 case and the dilatation by PTCS in 5 cases, including 3 endoprostheses by pig-tail silicone catheter and 2 internal-external biliary drainage. Two patients who did not undergo cholangioscopic dilatation died of sepsis due to cholangitis. Three of 5 patients who underwent endoscopic dilatation by PTCS could return to social life without recurrence of gallstones. In other two cases an endoprosthetic catheter was removed by PTCS because of dislodgement or obstruction of the catheter after confirming anastomotic strictures had improved. Authors recommended that PTCS should be applied for postoperative bile duct stricture complicated with intrahepatic stone.     

良性胆管狭窄行胆肠Roux-en-Y吻合术后再手术临床分析

目的 探讨良性胆管狭窄行胆肠Roux-en-Y吻合术后再手术的原因和再手术的方法.方法 回顾性分析良性胆管狭窄行胆肠Roux-en-Y吻合术后28例再次手术患者的临床资料.文中数据统计分析计量资料采用t检验,多因素分析采用Stepwise logistic回归分析.结果 再次手术原因为残余结石合并胆管狭窄10例,单纯吻合口狭窄11例,胆管狭窄6例,吻合口漏和十二指肠漏1例.再手术方式为:肝叶或肝段切除+胆肠Roux-en-Y吻合术18例,肝正中裂劈开+胆肠Roux-en.Y吻合术5例,右半肝切除术1例,吻合口狭窄段切除+胆肠Roux-en-Y吻合术1例,腹腔引流+十二指肠造瘘+空肠造瘘术1例,胆管切开取石+T管引流术2例,术后发生并发症13例.结论 胆道再手术病情复杂,手术难度高,详细了解病情和正确的手术方式是良性胆管狭窄再手术成功的关键.     

Choledochal cyst, pancreatobiliary malunion, and cancer

A review of the clinical features of biliary cancer with choledochal cyst and pancreatobiliary malunion is presented, together with a recent case report. Biliary cancer develops in about 25% of patients with choledochal cyst and pancreatobiliary malunion, and usually occurs in younger patients (usually those in their 40s) than does biliary carcinoma in the general population. The risk of malignancy in the retained cyst with internal drainage is higher than that in the primary cyst. Early excision of the retained cyst should be performed as quickly as possible, even if the patient is symptomless. Some bile acid fractions and refluxed pancreatic enzymes in bile are possibly responsible for carcinogenesis. Carcinoma generally develops in the extrahepatic bile duct and gallbladder, and rarely in the intrahepatic bile duct. In cystic dilatation, cancer usually occurs in the common bile duct, while in diffuse or non-dilated type, it develops in the gallbladder. Multicentric carcinomas develop in the bile duct either synchronously or metachronously. The prognosis of biliary cancer is usually dismal. However, aggressive procedures are now gaining better results than conventional approaches. The procedure of choice for choledochal cyst or malunion is to prevent the development of cancer by performing an early excision. Removal of the entire extrahepatic bile duct is necessary, even in patients with malunion and no biliary dilatation. Carcinoma rarely arises in the intrahepatic bile duct after excisional surgery, probably due to the long-standing stricture of the bile duct. Capacious anastomosis and/or ductoplasty is essential. Carcinoma may also develop in the remnant bile duct. Excision of the distal duct extending into the pancreas is also necessary.     

Congenital choledochal cyst: Occurrence of primary intrahepatic stones and prevention of carcinogenesis

Intrahepatic biliary stones and carcinogenesis are two major complications seen after corrective surgery for congenital choledochal cyst. The incidence of these two complications was reviewed in patients seen at out-patient clinics at a mean follow-up time of 13 years and 6 months. Intrahepatic biliary stones developed in 5 of 56 patients who had undergone a standard excisional operation; in 4 of the 5 patients, the stones were found in the preexisting intrahepatic biliary dilatation (with or without a downstream stenosis), 7–15 years postoperatively. Biliary stricture with dilatation is a putative cause of intrahepatic bile duct stones, and this hypothesis was supported here, since stones developed in all 3 of the patients who had the peculiar configuration of intrahepatic biliary dilatation and stenosis. Biliary carcinoma was not observed in any of the 56 patients who had undergone standard excision of a choledochal cyst followed by hepatico-jejunostomy, but developed in 1 of 12 patients in whom complete excisional resection of the dilated extrahepatic bile duct had not been performed. The occurrence of carcinoma in choledochal cysts is reviewed.     

Development of intrahepatic biliary stones after excision of choledochal cysts

Background: The incidence of intrahepatic cholelithiasis and cholangitis has not yet been well studied postoperatively in patients with choledochal cysts. Methods: One hundred three patients with choledochal cysts had operative cholangiography, underwent standard excision of a choledochal cyst with Roux-en-Y hepatico-jejunal anastomosis, and were at a mean follow-up of 12[frac12] years. The incidence of intrahepatic bile duct stones was analyzed according to the 3 morphologic types of intrahepatic bile duct observed at initial operative cholangiography: type 1, no dilatation of the intrahepatic bile ducts; type 2, dilatation of the intrahepatic bile ducts but without any downstream stenosis; and type 3, dilatation of the intrahepatic bile ducts associated with downstream stenosis. Initially, there was no evidence of intrahepatic bile duct stones in any of the 103 patients. Results: Among 50 type 1 patients, intrahepatic cholelithiasis developed in only 1 patient (2%). Among 43 type 2 patients, 1 patient (2%) had intrahepatic cholelithiasis, and 2 (5%) had postoperative cholangitis. Among 10 type 3 patients, 4 (40%) had intrahepatic cholelithiasis (P [lt ] .01), and 3 (30%) had postoperative cholangitis. Time intervals between the initial surgery and the first identification of intrahepatic stones ranged from 3 to 22 years. Conclusions: One of the major causes of formation of intrahepatic cholelithiasis has been clarified; patients with intrahepatic biliary dilatation with downstream stenosis can get intrahepatic bile duct stones long after excision of a choledochal cyst.     

Choledochal cysts: a retrospective review of 28 patients and a review of the literature.

Retained choledochal cysts have been associated with recurrent cholangitis, portal hypertension and malignant lesions of the biliary tract. The authors reviewed the cases of 23 females and 5 males who had congenital cystic dilatation of the biliary tree; 26 were seen primarily and 2 were referred because of complications from previous surgery. Patient age at presentation ranged from 6 weeks to 46 years. The presenting complaints in 25 patients were pain or jaundice, or both; the classic triad of pain, jaundice and an abdominal mass was present in only 3 patients. Primary cyst excision was performed in 11 patients. Internal drainage procedures were performed in 12 patients, external drainage procedures in 3 patients and no direct operative procedure in 2 patients. Follow-up ranged from 1 to 20 years. Nine of 11 patients with primary excision were asymptomatic; 2 had recurrent cholangitis and required treatment for bile duct stricture. Five patients with retained cysts were asymptomatic. Recurrent cholangitis occurred in seven patients. Six patients required at least one reoperation, but only two had secondary cyst excision. The long-term complication rate for patients with retained cysts was 66.7% and for those with primary excision was 18%. The findings of this study support the current recommendation of primary excision of choledochal cysts. Symptomatic patients with retained cysts should have secondary cyst excision. Asymptomatic patients with retained cysts are at risk for malignancy and should undergo lifelong periodic radiologic examinations and liver-function testing.     

先天性胆总管囊肿再次手术的原因分析及治疗

目的 探讨先天性胆总管囊肿再次手术的原因及治疗方法.方法 对41例先天性胆总管囊肿再次手术患者的临床资料进行总结分析.结果 按先天性胆总管囊肿Todani分型,41例中Ⅰ型32例,Ⅱ型1例,Ⅳ型3例,Ⅴ型5例(其中1例呈弥漫性左右肝分布).既往有1次胆道手术史者30例,2次者8例,3次者3例.41例中合并有胆管结石40例,胆道感染33例,肝门部胆管狭窄7例,原胆肠吻合口狭窄6例,囊肿癌变5例.本次行切除肝外胆管囊肿、肝管空肠Boux-en-Y吻合术者32例,其中2例囊肿癌变者同时行肝十二指肠韧带骨骼化和区域淋巴结清扫术;行肝叶切除联合胆总管囊肿切除、肝管空肠Roux-en-Y吻合术者8例;行胆肠吻合口狭窄切开成形、胆肠内引流重建术1例.41例术后均获随访,随访时间3个月至10年,平均53.7±32.1个月,随访期内发生胆道感染4例,无吻合口狭窄或结石复发等并发症发生.结论 胆总管囊肿术式选择不当及诊断失误导致的多种并发症是导致再手术的主要原因,肝内外胆管囊肿切除、肝管空肠Roux-en-Y吻合术可取得较为满意的疗效.     

The experience of biliary tract complications after liver transplantation

AIM: To report the morbidity and mortality of patients who undergo liver transplantation with or without T-tube implantation after choledochocholedochostomy as well as to discuss management of biliary complications. PATIENTS AND METHODS: We performed a retrospective review of 104 liver transplantations from August 2001 to February 2006, including 51 patients who underwent choledochocholedochostomy with a T-tube (group A) and 53, without a T-tube (group B). We compared the clinical characteristics, operative methods, biliary complications, morbidity, mortality, and management of complications. RESULTS: Between the two groups, there were no significant differences in clinical characteristics, including sex, age, and indication for liver transplantation (hepatitis B virus, hepatitis C virus, alcoholic liver cirrhosis, or hepatocellular carcinoma), Child-Pugh classification, Model for End-stage Liver Disease score, and operative macroscopic/microscopic findings. Additionally, there was no significant difference in biliary complications. Among these 104 patients, 14 (13.5%) developed biliary complications: seven anastomotic strictures, two intrahepatic duct strictures, two anastomotic stricture combined intrahepatic duct stricture, one bile leakage, one bile leakage combined with anastomotic stricture, and one external biliary compression. Nine patients with anastomotic stricture underwent endoscopy with a stent, which was successful only in two patients. The other six patients underwent choledochojejunostomy with excellent results. CONCLUSIONS: This study showed choledochocholedochostomy with or without a T-tube after liver transplantation did not influence the biliary complications. The biliary complications of anastomotic stricture after liver transplantation can be managed by endoscopy with a stent. If endoscopy fails, surgical intervention should be considered immediately.     

Intrahepatic cholangiocarcinoma arising 34 years after excision of a type IV-A congenital choledochal cyst: Report of a case

We report a rare case of intrahepatic cholangiocarcinoma (IHCC) arising many years after excision of a type IV-A congenital choledochal cyst. A 44-year-old man was transferred to our hospital with acute cholangitis more than 34 years after several operations for congenital biliary dilatation. Imaging showed a huge tumor in the left medial section of the liver, extending to the porta hepatis. Although he had no jaundice, the intrahepatic bile ducts showed cylinder-like dilatation with narrowing of the hilar bile duct. At surgery, the tumor was found to arise from the dilated intrahepatic bile duct just above the narrow portion. He underwent a left hepatic trisectionectomy with a vascular procedure. Microscopically, the tumor was confirmed to be moderate-to-well-differentiated tubular adenocarcinoma. Thus, when the narrow segment is left untouched, careful long-term follow-up is important to detect new lesions at an early stage.     

Bile duct cysts in adults: a multi-institutional retrospective study. French Associations for Surgical Research.

OBJECTIVE: To review the features of adult patients undergoing surgery for bile duct cysts, focusing on the anatomy of the biliary tree as well as the long-term outcome. SUMMARY BACKGROUND DATA: Bile duct cysts (BDCs) are uncommon in Western countries, and the majority of reported cases originate from Asia. Japanese authors have emphasized the frequent association of extra- and intrahepatic bile duct dilatations, but grading of patients based on Todani's classification is often hindered by the absence of an accurate definition of types IC and IVA cysts. Moreover, despite the increasing use of extrahepatic cyst excision, little is known about the long-term outcome in patients with intrahepatic bile duct involvement. METHODS: Forty-two adult patients with BDC were treated between 1980 and 1992 in 17 institutions of the French Associations for Surgical Research. Clinical presentation, radiologic presurgical evaluation, and surgical procedures were analyzed. The long-term postsurgical outcome was derived from patient charts, attending physicians, or direct patient contact. RESULTS: Twelve patients (30%) had recurrent abdominal pain or jaundice from childhood. Seven (17%) had undergone prior cystenterostomy. Twenty-one (50%) had a Todani-type IVA cyst with extra- and intrahepatic bile duct involvement. Of these, nine had segmental, exclusively left-sided intrahepatic bile duct dilatation. Biliary carcinoma was encountered in five patients (12%). Extrahepatic cyst excision with a Roux-en-Y hepaticojejunostomy was performed in 34 patients with type I or IV cysts. The overall operative mortality rate was 2.4%. Long-term results were clearly correlated with cyst type: during a mean follow-up of 8.4 years, 11 of 12 patients (92%) treated by cyst excision for type I cyst remained free of symptoms, whereas 31% of patients who underwent surgery for type IV cyst had episodic or severe cholangitis with intrahepatic stones. CONCLUSIONS: In patients with BDC, particular attention must be given to the associated intrahepatic bile duct dilatations. We propose a modification of Todani's classification to distinguish cystic, segmental, and fusiform dilatations of the intrahepatic biliary tree in type IV cysts. In patients with segmental left intrahepatic cystic dilatations, combined left liver lobectomy and extrahepatic cyst excision is suggested to decrease late postsurgical biliary complications.     

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??The treatments of long-term postoperative complications of congenital choledochal cyst LIU Yuan*, LIU Bing-yang, ZHOU Yong, et al. *Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author??LIU Jin-gang??E-mail??liujg@sj-hospital.org
Abstract Objective To investigate the experience of treatments of long-term postoperative complications in congenital choledochal cyst (CCC). Methods Retrospective analysis of the clinical data of postoperative patients with long-term complications in 48 cases of CCC patients from January 1999 to December 2008 in Shengjing hospital of China Medical University. Results The long-term postoperative complications of CCC mainly included 31 cases of biliary lithiasis, 25 cases of repeated cholangitis, 16 cases of stoma stenosis, 3 cases of cyst cancerization. The reoperative methods included complete cyst excision and Roux-en-Y hepatojejunostomy in 28 cases, excision of hepatojejunostomy and reanastomosis in 7 cases, biliary duct exploration and calculus removed in 3 cases, biliary duct exploration and hepatic segment excision in 3 cases, cyst excision and pancreatoduodenectomy in 1 case. 6 cases of stoma stenosis and/or intrahepatic calculus were managed by percutaneous transhepatic cholangioscopy (PTCS). Conclusions The long-term postoperative complications of CCC are usually correlated with inappropriate initial operation. In order to prevent the complications of reoperation, the aims for treatment should include cyst excision, calculous focus removing, obstruction disengage, biliopancreatic shunt, and biliary drainage unobstruction.