Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct

Dryazhenkov Gennady Ivanovich; Dryazhenkov Igor Gennadievich; Balnykov Sergei Igorevich; Kalashyan Eduard Vaziri; Sheronin Sergey Vladislavovich

doi:doi:10.11648/j.js.20231104.12

Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct

Dryazhenkov Gennady Ivanovich, Dryazhenkov Igor Gennadievich, Balnykov Sergei Igorevich, Kalashyan Eduard Vaziri, Sheronin Sergey Vladislavovich

Published in Journal of Surgery (Volume 11, Issue 4)

Received: 25 May 2023 Accepted: 25 June 2023 Published: 24 July 2023

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Abstract

Rationale: Cystic transformation of the bile ducts is rare. There are no publications on the complication of this pathology in the form of invagination of hepatic duct cysts. The search for optimal methods of surgical treatment of transformed cysts continues. Objective: To analyze the surgical treatment of patients with bile duct cysts, their complications and the choice of optimal methods of surgical correction depending on the localization of cysts. Material and methods: The 40–year experience of treating 15 women and 1 man with cystic transformation of the bile ducts is presented. There were 2 rare observations – the invagination of fragments of partially excised walls of confluence cysts of lobar ducts through their iatrogenic defect into the common hepatic duct. The main diagnostic methods were ultrasound, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography. Results: For intrahepatic cysts, left-sided hemihepatectomy (1), resection of 2 and 3 segments of the liver with simultaneous excision of all walls of the hepaticocholedoch cyst, hepaticoejunoanastomosis with isolated jejunum according to Roux (1) was performed. Invagination of fragments of partially excised walls of cysts confluence of lobar ducts through their iatrogenic defect into the common hepatic duct was eliminated using disinvagination through hepaticotomy (1) and resection of hepatic ducts with invaginate with the creation of a bigepaticoejunoanastomosis into the intestinal ring of the isolated jejunum (1). The walls of the cysts of the ducts of the subhepatic localization were completely excised (11) using bigepaticoejunoanastomosis into the intestinal ring of the isolated jejunum (2), hepaticoejunostomy according to Roux (9). Cystoenteroanastomosis according to Brown was performed in 2 patients. Regarding the membranous intra-current septa, their excision (1) and resection of the stenosed left hepaticoejunoanastmosis (1) were required. There were no fatal outcomes. Unresectable tumors of the subhepatic space were found in 2 patients 13 and 15 years after complex excision of cysts with hepaticoejunostomy. Conclusion: We use active surgical tactics: complete excision of the cyst walls, the creation of a hepaticoejunoanastomosis using an isolated intestinal loop according to Roux and a resection technique for single-lobar liver lesion with cysts. Diagnosis of invagination of cystic fragments into the ducts requires highly informative equipment, treatment requires specialized surgical care.

Published in	Journal of Surgery (Volume 11, Issue 4)
DOI	10.11648/j.js.20231104.12
Page(s)	81-86
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Bile Ducts, Cyst, Invagination, Surgery

References

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[2]	Vorobey AV, Orlovsky YuN, Vizhinis EI et al. Cystic transformation of the bile ducts. Annals of surgical hepatology. 2014; 4: 56. (In Russ).
[3]	Cerwenka H. Bile duct cyst in adults: Interventional treatment, resection, or transplantation? World J Gastroenterol. 2013; 19 (32): 5207-5211 PMID: 23983423 DOI: 10.3748/wjg.v19.i32.5207.
[4]	Martinez-Ordaz JL, Nino-Solis J. Choledochal cysts in adults. Cir. Ciruj. 2010; 78 (1): 61-66. PMID: 20226129.
[5]	Nichitailo ME, Galochka IP, Skums AV et al. Cystic transformation of bile ducts: surgical treatment and long-term results. Annals of surgical hepatology. 2000; 2: 43–47. (In Russ).
[6]	Chernousov AF, Egorov AV, Vetshev FP et al. Surgical treatment of cystic diseases of bile ducts. Pirogov Russian Journal of Surgery. 2016; 1: 85-92. (In Russ). doi: 10.17116/2016185-92.
[7]	Stain SC, Guthrie CR, Yellin AE, et al. Choledochal cyst in the adult. Ann Surg. 1995; 222 (2): 128-133. doi: 10.1097/00000658-199508000-00004.
[8]	Sastry AV, Abbadessa B, Wayne MG, et al. What is the incidence of biliary carcinoma in choledochal cysts, when do they develop, and how should it affect management? World J Surg. 2015; 39 (2): 487-492. doi: 10.1007/s00268-014-2831-5.
[9]	Nguyen T, Cheremnov VS, Kozlov YuA. Choledochal cysts – state of the art. Russian Journal of Pediatric Surgery. 2021; 25 (1): 37-43. (In Russ). doi: https://dx.doi.org/10.18821/1560-9510-2021-25-1-37-43.
[10]	Oweida SW, Ricketts RR. Hepatico-jejuno-duodenostomy reconstruction following excision of choledochal cysts in children. Am Surg. 1989; 55 (1): 2-6. PMID: 2913904.
[11]	Caroli J, Couinaud C, Soupault R, et al. A new disease, undoubtedly congenital, of the bile ducts: unilobar cystic dilation of the hepatic ducts. Sem Hop. 1958; 34 (8): 496-502/SP. PMID: 13543376.
[12]	Longmire WP, Mandiola SA, Gordon НЕ. Congenital cystic disease of the liver and biliary system. Ann. Surg. 1971; 174 (4): 711-726. PMID: 5098229 doi: 10.1097/00000658-197110000-00014.
[13]	Gigot JF, Nagorney DM, Farnell MB et al. Bile duct cysts: A changing spectrum of presentation. Journal of Hepato-Biliary-Pancreatic Surgery. 1996; 3: (4): 405–411.
[14]	Alonso-Lej F, Rever WB, Pessagno DJ. Congenital choledochal cyst, with a report of 2, and an analysis of 94 cases. Int Abstr Surg. 1959; 108 (1): 1-30. PMID: 13625059.
[15]	Dryazhenkov GI, Petrenko TF, Poрunin YuG, Dryazhenkov IG. Surgical treatment of intrahepatic bile duct injuries. Pirogov Russian Journal of Surgery. 1990; 1: 30-34. (In Russ).
[16]	Dryazhenkov GI, Dryazhenkov IG. Surgery of the hepatic ducts. Yaroslavl. Publishing House of OJSC "Rybinsk Printing House", 2009; 231. (In Russ.)
[17]	Ando Н, Ito Т, Kaneko К, et al. Congenital stenosis of the intrahepatic bile duct associated with choledochal cyst. J. Amer. Coll. Surg. 1995; 181: 426-430. PMID: 7582210.

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Dryazhenkov Gennady Ivanovich, Dryazhenkov Igor Gennadievich, Balnykov Sergei Igorevich, Kalashyan Eduard Vaziri, Sheronin Sergey Vladislavovich. (2023). Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct. Journal of Surgery, 11(4), 81-86. https://doi.org/10.11648/j.js.20231104.12

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Dryazhenkov Gennady Ivanovich; Dryazhenkov Igor Gennadievich; Balnykov Sergei Igorevich; Kalashyan Eduard Vaziri; Sheronin Sergey Vladislavovich. Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct. J. Surg. 2023, 11(4), 81-86. doi: 10.11648/j.js.20231104.12

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AMA Style

Dryazhenkov Gennady Ivanovich, Dryazhenkov Igor Gennadievich, Balnykov Sergei Igorevich, Kalashyan Eduard Vaziri, Sheronin Sergey Vladislavovich. Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct. J Surg. 2023;11(4):81-86. doi: 10.11648/j.js.20231104.12

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@article{10.11648/j.js.20231104.12,
  author = {Dryazhenkov Gennady Ivanovich and Dryazhenkov Igor Gennadievich and Balnykov Sergei Igorevich and Kalashyan Eduard Vaziri and Sheronin Sergey Vladislavovich},
  title = {Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct},
  journal = {Journal of Surgery},
  volume = {11},
  number = {4},
  pages = {81-86},
  doi = {10.11648/j.js.20231104.12},
  url = {https://doi.org/10.11648/j.js.20231104.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20231104.12},
  abstract = {Rationale: Cystic transformation of the bile ducts is rare. There are no publications on the complication of this pathology in the form of invagination of hepatic duct cysts. The search for optimal methods of surgical treatment of transformed cysts continues. Objective: To analyze the surgical treatment of patients with bile duct cysts, their complications and the choice of optimal methods of surgical correction depending on the localization of cysts. Material and methods: The 40–year experience of treating 15 women and 1 man with cystic transformation of the bile ducts is presented. There were 2 rare observations – the invagination of fragments of partially excised walls of confluence cysts of lobar ducts through their iatrogenic defect into the common hepatic duct. The main diagnostic methods were ultrasound, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography. Results: For intrahepatic cysts, left-sided hemihepatectomy (1), resection of 2 and 3 segments of the liver with simultaneous excision of all walls of the hepaticocholedoch cyst, hepaticoejunoanastomosis with isolated jejunum according to Roux (1) was performed. Invagination of fragments of partially excised walls of cysts confluence of lobar ducts through their iatrogenic defect into the common hepatic duct was eliminated using disinvagination through hepaticotomy (1) and resection of hepatic ducts with invaginate with the creation of a bigepaticoejunoanastomosis into the intestinal ring of the isolated jejunum (1). The walls of the cysts of the ducts of the subhepatic localization were completely excised (11) using bigepaticoejunoanastomosis into the intestinal ring of the isolated jejunum (2), hepaticoejunostomy according to Roux (9). Cystoenteroanastomosis according to Brown was performed in 2 patients. Regarding the membranous intra-current septa, their excision (1) and resection of the stenosed left hepaticoejunoanastmosis (1) were required. There were no fatal outcomes. Unresectable tumors of the subhepatic space were found in 2 patients 13 and 15 years after complex excision of cysts with hepaticoejunostomy. Conclusion: We use active surgical tactics: complete excision of the cyst walls, the creation of a hepaticoejunoanastomosis using an isolated intestinal loop according to Roux and a resection technique for single-lobar liver lesion with cysts. Diagnosis of invagination of cystic fragments into the ducts requires highly informative equipment, treatment requires specialized surgical care.},
 year = {2023}
}

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TY - JOUR
T1 - Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct
AU - Dryazhenkov Gennady Ivanovich
AU - Dryazhenkov Igor Gennadievich
AU - Balnykov Sergei Igorevich
AU - Kalashyan Eduard Vaziri
AU - Sheronin Sergey Vladislavovich
Y1 - 2023/07/24
PY - 2023
N1 - https://doi.org/10.11648/j.js.20231104.12
DO - 10.11648/j.js.20231104.12
T2 - Journal of Surgery
JF - Journal of Surgery
JO - Journal of Surgery
SP - 81
EP - 86
PB - Science Publishing Group
SN - 2330-0930
UR - https://doi.org/10.11648/j.js.20231104.12
AB - Rationale: Cystic transformation of the bile ducts is rare. There are no publications on the complication of this pathology in the form of invagination of hepatic duct cysts. The search for optimal methods of surgical treatment of transformed cysts continues. Objective: To analyze the surgical treatment of patients with bile duct cysts, their complications and the choice of optimal methods of surgical correction depending on the localization of cysts. Material and methods: The 40–year experience of treating 15 women and 1 man with cystic transformation of the bile ducts is presented. There were 2 rare observations – the invagination of fragments of partially excised walls of confluence cysts of lobar ducts through their iatrogenic defect into the common hepatic duct. The main diagnostic methods were ultrasound, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography. Results: For intrahepatic cysts, left-sided hemihepatectomy (1), resection of 2 and 3 segments of the liver with simultaneous excision of all walls of the hepaticocholedoch cyst, hepaticoejunoanastomosis with isolated jejunum according to Roux (1) was performed. Invagination of fragments of partially excised walls of cysts confluence of lobar ducts through their iatrogenic defect into the common hepatic duct was eliminated using disinvagination through hepaticotomy (1) and resection of hepatic ducts with invaginate with the creation of a bigepaticoejunoanastomosis into the intestinal ring of the isolated jejunum (1). The walls of the cysts of the ducts of the subhepatic localization were completely excised (11) using bigepaticoejunoanastomosis into the intestinal ring of the isolated jejunum (2), hepaticoejunostomy according to Roux (9). Cystoenteroanastomosis according to Brown was performed in 2 patients. Regarding the membranous intra-current septa, their excision (1) and resection of the stenosed left hepaticoejunoanastmosis (1) were required. There were no fatal outcomes. Unresectable tumors of the subhepatic space were found in 2 patients 13 and 15 years after complex excision of cysts with hepaticoejunostomy. Conclusion: We use active surgical tactics: complete excision of the cyst walls, the creation of a hepaticoejunoanastomosis using an isolated intestinal loop according to Roux and a resection technique for single-lobar liver lesion with cysts. Diagnosis of invagination of cystic fragments into the ducts requires highly informative equipment, treatment requires specialized surgical care.
VL - 11
IS - 4
ER -

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Author Information

Dryazhenkov Gennady Ivanovich

Department of General Surgery, Yaroslavl Regional Clinical Hospital, Yaroslavl, Russia
Dryazhenkov Igor Gennadievich

Department of Hospital Surgery, Yaroslavl State Medical University, Yaroslavl, Russia
Balnykov Sergei Igorevich

Department of Hospital Surgery, Yaroslavl State Medical University, Yaroslavl, Russia
Kalashyan Eduard Vaziri

Department of General Surgery, Yaroslavl Regional Clinical Hospital, Yaroslavl, Russia
Sheronin Sergey Vladislavovich

Department of General Surgery, Yaroslavl Regional Clinical Hospital, Yaroslavl, Russia

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APA Style

Dryazhenkov Gennady Ivanovich, Dryazhenkov Igor Gennadievich, Balnykov Sergei Igorevich, Kalashyan Eduard Vaziri, Sheronin Sergey Vladislavovich. (2023). Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct. Journal of Surgery, 11(4), 81-86. https://doi.org/10.11648/j.js.20231104.12

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Dryazhenkov Gennady Ivanovich; Dryazhenkov Igor Gennadievich; Balnykov Sergei Igorevich; Kalashyan Eduard Vaziri; Sheronin Sergey Vladislavovich. Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct. J. Surg. 2023, 11(4), 81-86. doi: 10.11648/j.js.20231104.12

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AMA Style

Dryazhenkov Gennady Ivanovich, Dryazhenkov Igor Gennadievich, Balnykov Sergei Igorevich, Kalashyan Eduard Vaziri, Sheronin Sergey Vladislavovich. Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct. J Surg. 2023;11(4):81-86. doi: 10.11648/j.js.20231104.12

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@article{10.11648/j.js.20231104.12,
  author = {Dryazhenkov Gennady Ivanovich and Dryazhenkov Igor Gennadievich and Balnykov Sergei Igorevich and Kalashyan Eduard Vaziri and Sheronin Sergey Vladislavovich},
  title = {Invagination of Transformed Confluence Cysts of Lobar Ducts into the Common Hepatic Duct},
  journal = {Journal of Surgery},
  volume = {11},
  number = {4},
  pages = {81-86},
  doi = {10.11648/j.js.20231104.12},
  url = {https://doi.org/10.11648/j.js.20231104.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20231104.12},
  abstract = {Rationale: Cystic transformation of the bile ducts is rare. There are no publications on the complication of this pathology in the form of invagination of hepatic duct cysts. The search for optimal methods of surgical treatment of transformed cysts continues. Objective: To analyze the surgical treatment of patients with bile duct cysts, their complications and the choice of optimal methods of surgical correction depending on the localization of cysts. Material and methods: The 40–year experience of treating 15 women and 1 man with cystic transformation of the bile ducts is presented. There were 2 rare observations – the invagination of fragments of partially excised walls of confluence cysts of lobar ducts through their iatrogenic defect into the common hepatic duct. The main diagnostic methods were ultrasound, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography. Results: For intrahepatic cysts, left-sided hemihepatectomy (1), resection of 2 and 3 segments of the liver with simultaneous excision of all walls of the hepaticocholedoch cyst, hepaticoejunoanastomosis with isolated jejunum according to Roux (1) was performed. Invagination of fragments of partially excised walls of cysts confluence of lobar ducts through their iatrogenic defect into the common hepatic duct was eliminated using disinvagination through hepaticotomy (1) and resection of hepatic ducts with invaginate with the creation of a bigepaticoejunoanastomosis into the intestinal ring of the isolated jejunum (1). The walls of the cysts of the ducts of the subhepatic localization were completely excised (11) using bigepaticoejunoanastomosis into the intestinal ring of the isolated jejunum (2), hepaticoejunostomy according to Roux (9). Cystoenteroanastomosis according to Brown was performed in 2 patients. Regarding the membranous intra-current septa, their excision (1) and resection of the stenosed left hepaticoejunoanastmosis (1) were required. There were no fatal outcomes. Unresectable tumors of the subhepatic space were found in 2 patients 13 and 15 years after complex excision of cysts with hepaticoejunostomy. Conclusion: We use active surgical tactics: complete excision of the cyst walls, the creation of a hepaticoejunoanastomosis using an isolated intestinal loop according to Roux and a resection technique for single-lobar liver lesion with cysts. Diagnosis of invagination of cystic fragments into the ducts requires highly informative equipment, treatment requires specialized surgical care.},
 year = {2023}
}

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