Caroli's disease surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Surgery
Intrahepatic biliary cyst treatment depends on degree of involvement.
- Segmental disease can be potentially cured with lobectomy. The risks and benefits of undergoing this surgery, versus the associated risks of future cholangitis, stone disease, pancreatitis, and liver abscess if not treated surgically have to be weighed in individual patients.
- If both lobes are involved, surgical resection may not be an option.
- If patients have recurrent cholangitis, a trial of prophylactic antibiotics could be considered.
- Liver transplant is a final option.
- Cholecystectomy is indicated because it reduces the likelihood of cholangitis, and because the gallbladder is at increased risk of malignancy in patients with biliary cysts.
- A report in the Lancet describes a significant improvement in stone disease in Caroli’s disease patients treated with ursodeoxycholic acid (Actigall) 10-20 mg/kg/d.
Extrahepatic biliary cysts are often treated with surgical repair due to risks of cyst rupture with secondary peritonitis, cholangitis and liver cirrhosis.
- Surgical options include primary cyst excision, and internal drainage procedures, such as choledochoduodenostomy and Roun-en-Y choledochojejunostomy. The down sides of internal drainage include a high complication rate and risk of malignancy in the abnormal region (2.5%).