Choledochal cysts: differences between pediatric and adult patients

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Hepatobiliary Surgery

Background:

• Choledochal cysts are congenital bile duct dilatations.
• Previous studies suggest differences between pediatric and adult presentations, but direct comparisons are limited.

Purpose of the Study:

• To identify and compare clinicopathological differences in choledochal cysts between pediatric and adult patients.
• To evaluate differences in associated pancreaticobiliary anomalies and long-term outcomes.

Main Methods:

• Retrospective analysis of 42 pediatric and 59 adult patients with choledochal cysts.
• Comparison of clinical presentation, associated anomalies, complications, and treatment outcomes.
• Mean follow-up period of 8.9 years.

Main Results:

• Pediatric patients more frequently presented with abdominal mass and less with abdominal pain compared to adults.
• Pediatric cases showed higher association with anomalous pancreaticobiliary ductal union and terminal choledochal stenosis.
• Adults had a higher incidence of choledocholithiasis and malignant transformation (21.2%) compared to children (0%).
• Pediatric patients experienced fewer perioperative and long-term complications.

Conclusions:

• Choledochal cysts in children and adults present with significant differences in clinicopathological features, pancreaticobiliary anomalies, and prognosis.
• Management strategies for choledochal cysts should be individualized based on patient age and specific characteristics.
• Total excision is associated with fewer surgical complications in both pediatric and adult groups.