Surgical treatment for pancreaticobiliary maljunction and congenital biliary dilatation

Abstract

Various complications may arise due to the mutual reflux of bile and pancreatic juice in cases of pancreaticobiliary maljunction and congenital biliary dilatation. To prevent the development of biliary tract cancer, "extrahepatic choledochotomy and biliary tract reconstruction" is the recommended standard treatment. However, characteristic postoperative complications, such as intrahepatic stones and residual cholangiocarcinoma, are not uncommon, especially in the long term. When planning surgical treatment, it is important to thoroughly understand the pathophysiology, including relative stenosis at the hepatic hilum, congenital stenosis of the intrahepatic bile ducts, and the anastomotic morphology of the bile and pancreatic ducts. In non-dilated cases, the risk of carcinogenesis is not well understood, and there is no consensus on the necessity of bile duct resection. Unified diagnostic criteria for "non-dilated" cases across institutions, along with case accumulation and cancer risk assessment, are anticipated. With advancements in surgical techniques, minimally invasive procedures, such as laparoscopic and robot-assisted surgeries, are being used more frequently. While these procedures are expected to be widely adopted due to their minimally invasive nature and cosmetic advantages, significant technical challenges remain, including intraoperative and long-term postoperative complications.