In Reply.—Alper and colleagues raise a number of interesting points.
We agree that debris from the
cysts may obstruct the common bile duct and that a "wide choledochoduodenostomy" might provide definitive drainage. In none of our patients, however, was debris found in the common bile duct after operation. Thus, it is difficult to propose a choledochoduodenostomy for all patients with cystic biliary communication.
We agree that in some cases a long-standing obstruction may cause late secondary sclerosing cholangitis. It is also possible that this secondary sclerosing cholangitis may occur without proximal dilatation. However, our patients' cases differed from these hypothetical situations on an important point: Sclerosing cholangitis took place early after operation.
Bacterial cholangitis was documented in only one case before the initial operation. It is generally accepted that bacterial cholangitis is a consequence and not the cause of sclerosing cholangitis.
We believe that the