Problems of the treatment for pancreaticobiliary maljunction, and proposal of the new classification

Abstract

107 cases of bile duct cancer after extrahepatic bile duct resection with congenital biliary dilatation were reported. In these patients, cancer was detected at a mean of 12.0 years after surgery and the incidence of bile duct cancer after surgery was 2.0%. Inadequate bile duct excision is likely to relate to this serious complication, because 74.5% of bile duct cancer occurred from the intrapancreatic remnant bile duct and the hepatic hilum after extrahepatic bile duct resection. Therefore, complete excision of the intrapancreatic bile duct and removal of stenoses of the hepatic ducts are necessary to prevent serious complications after surgery. On the other hand, diagnostic criteria for pancreaticobiliary maljunction without biliary dilatation in adult remains unclear and it is controversial whether preventive resection of the extrahepatic bile duct should be performed or not. To solve these problems, author will make a suggestion that pancreaticobiliary maljunction considering with stenosis of the hepatic duct can be classified into cystic type, spindle type, forme fruste and no dilatation type. In addition, this classification is connected with appropriate treatment.