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Management of choledochal cysts.

Sean M Ronnekleiv-Kelly1, Kevin C Soares, Aslam Ejaz

  • 1Department of Surgery, Division of Surgical Oncology, Johns Hopkins Hospital, Baltimore, Maryland, USA.

Current Opinion in Gastroenterology
|February 18, 2016
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Summary

Complete excision is now the standard for choledochal cyst treatment, reducing risks. Long-term follow-up is crucial as a slight risk of biliary malignancy persists after surgical resection.

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Area of Science:

  • Hepatobiliary Surgery
  • Pediatric Surgery
  • Gastroenterology

Background:

  • Choledochal cysts (CCs) are congenital biliary anomalies.
  • Historically treated with cyst enterostomy, this approach often led to complications.
  • Incomplete excision can cause recurrent symptoms and malignant transformation.

Purpose of the Study:

  • To review current management strategies for choledochal cysts.
  • To detail cyst-type specific surgical approaches.
  • To assess the impact of minimally invasive surgery and long-term sequelae.

Main Methods:

  • Review of current literature on choledochal cyst management.
  • Analysis of surgical approaches, including minimally invasive techniques.
  • Evaluation of long-term outcomes and complication rates.

Main Results:

  • Complete cyst excision is the preferred surgical approach.
  • Minimally invasive surgery offers acceptable morbidity and mortality.
  • Long-term follow-up shows a decreased but persistent risk of biliary malignancy post-excision.

Conclusions:

  • Management is tailored to patient comorbidities and cyst subtype.
  • Complete excision is recommended to mitigate complications.
  • Treatment at high-volume hepatopancreaticobiliary centers is advised due to complexity.