The Efficacy and Safety of Intrapancreatic Bile Duct Resection Applied in Type I of Congenital Bile Duct Dilation: A Multi-center Control Cohort Study.

To compare the efficacy and safety of radical extrahepatic cyst excision including the intrapancreatic bile duct (REC) and subtotal extrahepatic cyst excision preserving the intrapancreatic bile duct (SEC) in treating Todani type I congenital bile duct dilation (CBD) with intrapancreatic bile duct involvement (I-IPBD). The application of REC and SEC in I-IPBD remains debated. The multicenter study recruited I-IPBDs who underwent REC or SEC from 5 centers between 2006 and 2024. The primary endpoint was occurrence of long-term complications, including recurrent cholangitis, pancreatitis, and intrapancreatic bile duct stones. The secondary outcomes included readmission, reoperation, life quality assessed by Mayo score, carcinogenesis, and perioperative complications categorized as overall, severe, pancreas-related, and severe pancreas-related. 355 I-IPBDs were included and divided into the REC group (175 cases) and SEC (180 cases) from 722 type I CBDs. The REC group demonstrated better long-term complication-free survival compared to SEC group (log-rank P <0.001; HR=0.08, 95%CI: 0.04-0.15, P <0.001). The REC group had lower rates of readmission, reoperation, and carcinogenesis, and achieved a superior Mayo score (P <0.05). No significant differences were observed between the REC and SEC groups in overall perioperative complications, severe perioperative complications, and severe pancreas-related perioperative complications (P >0.05). Furthermore, subgroup analysis by age demonstrated similar trends in primary and secondary outcomes compared to the overall analysis. REC was an effective and safe surgical approach for I-IPBD compared with SEC, thus it should be recommended routinely for these patients.