Effectiveness of Roux-en-Y Hepaticojejunostomy in Reversing the Liver Histological Changes in Patients Presenting Symptomatically and Asymptomatically with Type I & IV Choledochal Cyst

Purpose: Choledochal cyst, a cystic dilatation of biliary tree, is a congenital abnormality of unknown etiology. Excision of cyst & biliary reconstruction is the mainstay of treatment. Most patients (80%) with choledochal cyst are detected after clinical manifestations. Majority is symptomatic patient and others are asymptomatic. Symptomatic patients have consequential impact on liver histology and function. These changes of liver histology may be reversible or irreversible depending in the degree and length of insult. This study attempt to identify whether symptomatic patients show more irreversible changes than asymptomatic choledochal cyst patients. Thus, the aim of this study was to determine the reversibility and irreversibility of the liver histological changes in patients presenting symptomatically and asymptomatically.

Methods: It is a prospective analytic study. Study period was from January 2017 to August 2018, done in Pediatric Surgery department of BSMMU & DMCH. This included 31 patients with choledochal cyst. They are divided in symptomatic patient and asymptomatic patient. Excision of the cyst with roux-en-Y hepaticojejunostomy and intra-operative liver biopsy was taken and liver biopsy was repeated after six months of surgery. Both the liver biopsies were compared & observe histologically in terms of reversibility and irreversibility in patients presenting symptomatically and asymptomatically.

Results: Thirty-one patients were included. Among them symptomatic patients were 22 and asymptomatic patients were 09. In both group pathological changes were observed in all the patients pre-excisionally and post-excisionally. In symptomatic patient significant histological changes were seen pre-excisionally. Nineteen were reversible group and threehad irreversible group. But in asymptomatic group all nine patients were reversible. Postexcisionally there was significant regression in reversible group both in symptomatic patients and asymptomatic patients. But post-excisionally irreversible group did not showreversibility even after successful roux-en-Y hepaticojejunostomy.

Conclusions: Liver histology shows various degree of changes in all choledochal cyst patients whether symptomatic or asymptomatic. Symptomatic patient demonstrates more irreversible changes than asymptomatic patients. Majority of the pathological changes of the liver in early stage are reversible after roux-en-Y hepaticojejunostomy. There is no short term liver architectural improvement of the patients with choledochal cyst evenafter successful roux-en-Y hepaticojejunostomy who pre-excisional had irreversible changes.