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Updated: Jul 6, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Estimation of postoperative fat absorption using the 13C mixed-triglyceride breath test in children with choledochal
Mitsuyoshi Suzuki1, Kyoko Tanaka, Kiyotaka Ohtani
1Department of Pediatrics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113 8421, Japan. f-mitsuo@zc5.so-net.ne.jp
Insights
Children with choledochal cyst (CC) undergoing Roux-en-Y (RY) hepatico-jejunostomy (HJ) may experience subtle fat malabsorption. This occurs even without obvious symptoms or abnormal lab results post-surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nutritional Science
Background:
- Choledochal cysts (CC) are congenital biliary anomalies often treated with cyst excision and Roux-en-Y (RY) hepatico-jejunostomy (HJ).
- This surgical approach creates a non-physiological mixture of food and bile, potentially impacting digestion and absorption.
- Postoperative fat malabsorption in pediatric CC patients after RYHJ has not been previously studied.
Purpose of the Study:
- To investigate the effect of RYHJ with cholecystectomy on fat absorption in children with CC.
- To identify potential occult fat malabsorption following this surgical procedure.
Main Methods:
- Utilized the carbon 13-labeled mixed triglyceride (13C-MTG) breath test to assess postoperative fat absorption.
- Compared 12 pediatric CC patients post-RYHJ with 12 healthy controls.
- Collected breath samples at intervals and measured fecal chymotrypsin activity and fecal fat excretion.
Main Results:
- Significantly lower delta values of breath 13CO2 at 3, 4, and 5 hours, and lower 5-hour cumulative breath 13CO2 in CC patients compared to controls.
- No significant differences were observed in fecal chymotrypsin activity between the groups.
- Fecal fat excretion did not differ significantly between the CC patient and control groups.
Conclusions:
- Occult fat malabsorption is present in pediatric patients with CC after RYHJ.
- This malabsorption can occur even in the absence of clinical symptoms or abnormal laboratory findings.
- The 13C-MTG breath test is a sensitive method for detecting subtle fat malabsorption post-RYHJ in CC patients.
Abstract:
No previous studies have focused on postoperative fat malabsorption in children with choledochal cyst (CC) who undergo cyst excision and Roux-en-Y (RY) hepatico-jejunostomy (HJ), a combination of procedures that can lead to the non-physiological mixture of food and bile juice. To examine the effect of RYHJ with cholecystectomy on the fat absorption ability of children with CC, we estimated postoperative fat-absorption ability using the carbon 13-labeled mixed triglyceride (13C-MTG) breath test. Twelve postoperative children with CC and 12 normal control children were administered 13C-MTG orally and asked to give breath samples at six time points: once before the 13C-MTG ingestion and at five 60-min intervals postingestion. Fecal chymotrypsin activity and fecal fat excretion were also measured. The delta value of breath 13CO2 at 3, 4, and 5 h after administration and the 5-h cumulative breath 13CO2 were significantly lower in the CC children than in the controls. There were no significant differences in the fecal chymotrypsin activity or fecal fat excretion of the two groups. Conclusion. Occult fat malabsorption occurs in patients with CC after RYHJ, even in the absence of clinical symptoms or abnormal laboratory data.
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