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A new classification of the anomalous arrangement of pancreaticobiliary ducts (APBD)
has been proposed following amendments and modifications of the previous one. Fifty-one
cases of choledochal cyst complicated with APBD were extensively examined and analyzed
for clear visualization of the APBD system to make a standard classification. APBD
were classified broadly into three types: type I, type II, and type III with their
subtypes. Type I of APBD was seen in 18 (35.3%), type II in 11 (21.6%) and type III
in 22 (43.1%) cases, respectively. A radical operation, including complete excision
of the dilated biliary duct followed by reconstruction of the biliary tract was the
surgical treatment of choice, because the reflux of the pancreatic juice into the
biliary tract is prevented. However, a dilated common channel or accessory pancreatic
duct, according to the new Komi type Ib, IIb, and IIIc3 of APBD, could be the cause of relapsing pancreatitis leading to chronic pancreatitis,
due to the formation of a protein plug or pancreatic calculus in the dilated duct,
even after this radical operation. In two complicated cases of type IIIc3 of APBD in choledochal cyst, we performed a pylorus-preserving pancreatoduodenectomy
as one of the operative methods of choice. Long-term follow-up, more than decades,
is essential to evaluate the results of surgical procedure for choledochal cyst, especially
in those complicated cases with type Ib, IIb, and IIIc3 of APBD according to the new Komi's classification.
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References
- Congenital dilatation of the biliary tract: New classification and study with particular reference to anomalous arrangement of the pancreaticobiliary ducts.Gastroenterol Jpn. 1977; 12: 293-304
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- New classification of anomalous arrangement of the pancreaticobiliary ducts (APBD) in choledochal cyst; a proposal of new Komi's classification of APBD.J Jpn Panc Soc. 1991; 6: 234-243
Article info
Footnotes
*Presented at the 24th Annual Meeting of the Pacific Association of Pediatric Surgeons, Hong Kong, May 20–24, 1991.
Identification
Copyright
© 1992 W.B. Saunders Company. All right reserved. Published by Elsevier Inc.
