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Footnotes Institutional review board statement: This study was approved by institutional review board Mansoura University. Informed consent statement: Informed consent was obtained from all patients to undergo surgery after a careful explanation of the nature of the disease and possible treatment with its complications. Conflict-of-interest statement: Verteporfin mw The authors declare that they have no conflict of interest. Data sharing statement: No additional data are available. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Peer-review started: Itraconazole February 14, 2016 First decision: March 14, 2016 Article in press: April 6, 2016 P- Reviewer: Bekheit M, Kassir R S- Editor: Qi Y L- Editor: A E- Editor: Wu HL""AIM: To analyze the impact of previous cyst-enterostomy of patients underwent congenital bile duct cysts (BDC) resection. METHODS: A multicenter European retrospective study between 1974 and 2011 were conducted by the French Surgical Association. Only Todani subtypes I and IVb were included. Diagnostic imaging studies and operative and pathology reports underwent central revision. Patients with and without a previous history of cyst-enterostomy (CE) were compared. RESULTS: Among 243 patients with Todani types I and IVb BDC, 16 had undergone previous CE (6.5%). Patients with a prior history of CE experienced a greater incidence of preoperative cholangitis (75% vs 22.9%, P Vandetanib reoperation rates (37.5% vs 8.8%; P = 0.0032) were also significantly greater in patients with previous CE, and their Mayo Risk Score, during a median follow-up of 37.5 mo (range: 4-372 mo) indicated significantly more patients with fair and poor results (46.1% vs 15.6%; P = 0.0136). CONCLUSION: This is the large series to show that previous CE is associated with poorer short- and long-term results after Todani types I and IVb BDC resection. Keywords: Bile duct cyst, Congenital, Biliary disease, Cyst-enterostomy, Long-term outcome Core tip: Previous cyst-enterostomy is associated with more severe clinical presentation, including increased incidence of synchronous cancer, as well as poorer short- and long-term results in patients undergoing operations for Todani types I and IVb bile duct cysts.