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Updated: Jun 17, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Management of choledochal cyst: 30 years of experience and results in a single center
Wong-Hoi She1, H Y Chung, L C L Lan
1Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
Insights
Surgical removal of choledochal cysts with Roux-en-Y hepaticojejunostomy offers good long-term outcomes in pediatric patients. Laparoscopic approaches are also effective for treating this congenital biliary anomaly.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Anomalies
Background:
- Choledochal cysts are typically diagnosed in childhood.
- Early intervention is crucial to prevent complications.
- This study reviews a 30-year patient series.
Purpose of the Study:
- To evaluate the clinical presentation, management, and long-term outcomes of pediatric choledochal cyst patients.
- To assess the efficacy of surgical interventions, including laparoscopic approaches.
- To analyze cyst classification and associated conditions.
Main Methods:
- Retrospective analysis of pediatric patients with choledochal cysts from 1978-2008.
- Data collection included clinical presentation, surgical management, and outcomes.
- Cysts were classified using the Todani system.
Main Results:
- Eighty-three pediatric patients were analyzed, with a mean age of 45 months at diagnosis.
- Abdominal pain and jaundice were the most frequent symptoms.
- Complete excision with Roux-en-Y hepaticojejunostomy was performed in 72 patients, with a 5.3% early complication rate and no mortality or malignant transformation.
Conclusions:
- Complete cyst excision and Roux-en-Y hepaticojejunostomy are the preferred treatments for choledochal cysts, yielding favorable long-term results.
- Laparoscopic surgery is a viable option.
- Long-term follow-up is essential for managing these patients.
Background:
Choledochal cyst is usually diagnosed in childhood. Early treatment can prevent further complication. We report on our series of patients over the past 30 years.
Methods:
A retrospective study was performed on all pediatric patients who presented with choledochal cyst from January 1978 to December 2008. The main outcome measures recorded were the clinical presentation, management, and long-term outcome of the patients.
Results:
Eighty-three patients presented to us during the caption period with a mean age at diagnosis of 45 months (0 month to 16 years). Diagnoses were made antenatally in 15 patients. The most common symptoms were abdominal pain (n = 39) and jaundice (n = 35). Seventy-five patients had surgery, in which 72 patients had resection of the cyst and Roux-en-Y hepaticojejunostomy. Ten were performed by laparoscopic means. We categorized the cysts based on the Todani classification. There was no mortality. No malignant change was documented. For those 4 who had Caroli disease, 2 underwent liver transplantation and 2 had hepatectomy. Overall early complication rate was 5.3% (4/75).
Conclusions:
Complete excision of cyst with Roux-en-Y hepaticojejunostomy is the treatment of choice, and the late result is good. Laparoscopic surgery is feasible. Long-term follow-up is necessary. There is no evidence to suggest that some type IV cysts are the result of disease progression from type I cysts.
