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Jiro Ohuchida, MD; Kazuo Chijiiwa, MD, PhD; Masahide Hiyoshi, MD; Kiichiro Kobayashi, MD; Hiroyuki Konomi, MD; Masao Tanaka, MD

Arch Surg. 2006;141:1066-1070.

Hypothesis  Resection of the gallbladder together with the dilated bile duct is the preferred treatment for pancreaticobiliary maljunction (PBM) with bile duct dilatation, whereas this treatment for PBM without bile duct dilatation is still controversial.

Design  Retrospective study of 196 patients from January 1979 to November 2004.

Setting  Two university hospitals.

Patients  One hundred ninety-six patients with PBM, 152 (78%) with and 44 (22%) without bile duct dilatation, formed the basis of this study.

Main Outcome Measures  The effects of cholecystectomy on long-term results in the patients without bile duct dilatation.

Results  Significant differences were observed in patients without bile duct dilatation: patients were older, carcinoma of the gallbladder was more prevalent (19 patients [43.2%] without dilatation vs 9 patients [5.9%] with dilatation), and pancreatic cancer and pancreatitis were also more frequent. Most of their gallbladder carcinomas were found at stage IV (63%). The outcome was very poor in stage IV, whereas 5 patients in stage I and II lived for more than 5 years after surgery. Of the 44 patients without bile duct dilatation, 23 with carcinoma of the gallbladder or pancreas died and the other 2 were lost to follow-up. The remaining 19 patients were alive at the study's conclusion after cholecystectomy without bile duct resection. None of them had bile duct carcinoma at the time of surgery or during the mean follow-up period of 9 years after surgery.

Conclusions  Prophylactic cholecystectomy without bile duct resection is the best treatment option for patients with PBM without bile duct dilatation. Possible association of gallbladder carcinoma should be kept in mind at the time of treatment of patients with PBM when the bile duct is not dilated.

Author Affiliations: Department of Surgery 1, Miyazaki University School of Medicine, Miyazaki, Japan (Drs Ohuchida, Chijiiwa, and Hiyoshi); and Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (Drs Kobayashi, Konomi, and Tanaka).

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