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Choledochal cysts in western adults: complexities compared to children
Michael Nicholl1, Henry A Pitt, Patrick Wolf
1Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
Summary
Western adults with choledochal cysts present differently than children, often with more complex cyst types and higher rates of malignancy. Surgery for these adults is complex and requires specialist care.
Area of Science:
- Hepatobiliary Surgery
- Pediatric Surgery
- Gastroenterology
Background:
- Choledochal cysts are rare in Western adults, with limited data on their management.
- Pediatric treatment protocols are established, but adult management remains less defined.
Purpose of the Study:
- To compare the clinical presentation, surgical management, and long-term outcomes of Western adults and children with choledochal cysts.
- To identify distinct characteristics and challenges in adult choledochal cyst cases.
Main Methods:
- Retrospective review of 57 patients with choledochal cysts across three academic institutions in Wisconsin.
- Analysis of patient demographics, cyst types, prior surgical history, management strategies, and late complications.
Main Results:
- Adults (54%) were more likely male, experienced more pain and cholangitis, and had higher rates of type IVa/V cysts.
- Adults more frequently had prior biliary surgery and required preoperative stenting.
- Biliary malignancy increased with age, and adults faced more late cholangitis and secondary biliary cirrhosis.
Conclusions:
- Western adults with choledochal cysts exhibit unique features, including complex cyst types, prior surgeries, and increased malignancy risk.
- Management of choledochal cysts in Western adults is often complicated and necessitates specialized surgical expertise.