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Application of Laparoscopic Ultrasonography in Primary Choledochal Suture during Combined Two-lens Surgery
Published on: March 28, 2025
[Choledochal cyst: a 10-year experience]
L H Pereira1, J M Bustorff-Silva, L Sbraggia-Neto
1Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
Insights
Early diagnosis and surgical resection of choledochal cysts lead to good outcomes. Most pediatric patients achieved symptom-free recovery after cyst resection and hepaticojejunostomy, though some developed chronic pancreatitis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Choledochal cysts are rare congenital biliary abnormalities predominantly affecting female infants and children.
- Optimal outcomes for choledochal cysts rely on timely diagnosis, complete surgical excision, and reconstruction with hepaticojejunostomy.
Purpose of the Study:
- To assess the long-term outcomes of 18 patients who underwent surgical management for choledochal cysts over a decade.
Main Methods:
- A retrospective chart review was conducted on 18 pediatric patients diagnosed with choledochal cysts.
- Surgical interventions included cyst resection and Roux-en-Y hepaticojejunostomy for most cases.
- Diagnostic modalities utilized were ultrasonography and endoscopic retrograde cholangio-pancreatography.
Main Results:
- The patient cohort ranged from 20 days to 13 years, with 83% being female.
- Common presenting symptoms included jaundice (83%), dark urine (61%), and abdominal pain (50%).
- Postoperative follow-up revealed 86% of patients were symptom-free, while 14% developed chronic pancreatitis. Two early deaths (11%) occurred due to liver function deterioration.
Conclusions:
- Surgical management, including cyst resection and Roux-en-Y hepaticojejunostomy, offers a favorable prognosis for most pediatric choledochal cyst patients.
- While effective, potential long-term complications such as chronic pancreatitis warrant continued monitoring.
Abstract:
BACKGROUND: Choledochal cyst is a rare abnormality usually found in infancy and childhood and mainly in females. Outcome depends on early diagnosis, complete resection of the cyst and proper hepaticoenterostomy.OBJECTIVE: The aim of this paper is to evaluate the outcome of 18 patients operated in ten years. METHODS: Retrospective chart review. RESULTS AND DISCUSSION: Age ranged between 20 days and 13 years (mean 3 years). Fifteen (83%) were female and 03 (17%) male. Signs presented included 15 (83%) with jaundice, 11 (61%) with dark urine, 10(55%) with pale colored stools, 09 (50%) with abdominal pain and palpable mass in only 02(11%). Ultrasonography identified the cyst in 14 (77%) patients. Endoscopic retrograde cholangio-pancreatography demonstrated a long common duct in three of four cases. Anatomical types were: 09 type I, 01 type II, 07 type IV and 01 type V. Except for one patient who had a type V cyst, all patients underwent cyst resection plus Roux-en-Y hepaticojejunostomy. There were two (11%) early postoperative deaths related to deterioration of liver function. Thirteen (86%) of the 15 patients available to follow-up were symptom-free without late complications at a mean period of three years, and two (14%) patients developed chronic pancreatitis.
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