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    Moutaz Ragab1,Mohamed Hamed Abouelfadl1, Mahmoud M. Marei 1
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  • Study of Splenic Injury in Belharzail Hepatic Fibrosis Patients Subjected To Blunt Abdominal Trauma
    Mahmoud Alhussinia, M. Ashraf Balbaab, Ahmed Tarek Awada, Tamer Abdelbakia
  • Choledochal Cysts in Adults: The Clinicopathological Features and Surgical Outcomes in a Single Institute.
    Ahmed El-Gendi1, Mohamed El-Shafei2, Essam Bedewy3
  • Banded Versus Non-Banded Sleeve Gastrectomy “Comparative Study”
    Elsobky A, MD
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  • Choledochal Cysts in Adults: The Clinicopathological Features and Surgical Outcomes in a Single Institute.

    Ahmed El-Gendi1, Mohamed El-Shafei2, Essam Bedewy3
    1Department of Surgery, Faculty of Medicine, Alexandria University, Egypt 2Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Alexandria University, Egypt; 3Department of Hepatology and Tropical Medicine, Faculty of Medicine, Alexandria University, Egypt

    Introduction: Choledochal cysts are believed to be a congenital disease however around 20% presents in adulthood. Direct comparison between them is seldom reported. The aim was to compare adult and pediatric choledochal cysts in patients of the same race treated in a single institution to highlight the difference in clinicopathological features, clinical presentation, management and surgical outcomes. Patients and Methods: From January 2015 to December 2018, 42 patients presented with diagnosis of choledochal cyst they were divided into two groups: pediatric group (below 18 years) and adult group (above 18 years). The following data was recorded and compared: demographic characteristics, presenting symptoms, diagnostic images, type of surgery, amylase level in the cyst, final pathology, perioperative complications, and follow-up data. Results: 24 pediatric patients (mean 4.5 years) and 18 adult patients (mean 32.4 years) were compared. There was significantly higher female predominance in pediatric group (p=0.03). The main complain at presentation was abdominal pain in adult group (77.8%) compared to abdominal mass in pediatric group (75%). The median amylase level in bile was 220 U/L (range = 15– 3580 U/L) in the pediatric group and 390 U/L (range = 37–12000 U/L) in the adult group with P=0.046. Pediatric group had a significant higher predominance for Type Ia cyst. There was no significant difference between the two groups as regards the incidence of gallstones or intrahepatic stones. Pediatric patients were statistically more frequently associated with APBDJ than adult patients (79.2% vs 44.4%, P=0.005). Excision of the cyst and hepaticojejunostomy was the most commonly performed procedure in both groups. Additional hepatic resection was needed for type V patients in two patients in both groups. Liver transplantation was performed for one type V patient in pediatric group. There was no 30 days mortality and no case of 30 days readmission. There was no statistical significant difference between adult and pediatric groups in 30 days morbidity and mortality (p=0.06). The median postoperative length of hospital stay was 7 days in adult group versus 8 days in pediatric group (p =0.65). The median follow-up duration was 24 months (range 15–48 months) in adult group and 26 months (range 14–45 months) in the pediatric group. Till the date of last follow up, all patients are still alive with no development of malignancy in either group. Conclusion: Choledochal cyst in Pediatrics are more likely to be associated with female predominance, present by abdominal mass, Type 1a cyst, and stones inside the choledochal cyst whereas adult patients commonly present by abdominal pain, and are more often associated with APBDJ. Excision of the entire extra hepatic biliary tree with hepaticojejunostomy is the most commonly performed surgical procedure in adults and pediatrics to treat extra hepatic cystic involvement with chronic abdominal pain with recurrent mild cholangitis is the most common long-term complication in both groups.