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Updated: Mar 20, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Choledochal Cyst Disease in a Western Center: A 30-Year Experience
Maitham A Moslim1, Hideo Takahashi2, Federico G Seifarth3
1Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. moslimm@ccf.org.
Insights
This study details Western experiences with choledochal cyst disease, finding varied presentations and management. Early detection of malignant transformation is crucial for timely surgical intervention.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Choledochal cysts are rare congenital bile duct dilatations.
- This study reports a Western cohort's experience with diagnosis and management.
- Disease presentation and management strategies are highly variable.
Purpose of the Study:
- To describe the diagnosis and management of choledochal cyst disease in a Western population.
- To analyze patient demographics, cyst types, and treatment outcomes.
- To highlight the importance of identifying malignant transformation.
Main Methods:
- Retrospective review of 67 patients diagnosed with choledochal cysts.
- Analysis of patient demographics, clinical presentation, cyst classification (Types I, II, IV, V), and surgical interventions.
- Evaluation of early and long-term postoperative complications and oncologic outcomes.
Main Results:
- 67 patients (76.1% female) diagnosed with choledochal cysts; 72% were symptomatic.
- Type I cysts were most common (73.1%).
- Malignancy was found in 5 adult patients, often incidentally detected.
- Significant early and long-term morbidity was observed post-surgery.
Conclusions:
- Choledochal cyst presentation and management vary significantly.
- Malignant transformation is frequently detected incidentally.
- Resection should be prioritized upon diagnosis due to the risk of malignancy.
Background:
The aim of this study was to report a Western experience in the diagnosis and management of choledochal cyst disease.
Results:
Sixty-seven patients were identified including 15 children and 52 adults; 76.1 % were females. The median age at diagnosis was 3 [inter-quartile range (IQR) = 6.0-0.7] years for children, and 46 [IQR = 55.6-34.3] years for adults. Forty-eight patients (72 %) were symptomatic. Types of choledochal cyst included: I (n = 49, 73.1 %), II (n = 1, 1.5 %), IV (n = 9, 13.4 %), and V (n = 8, 12 %). The median diameter of the type I choledochal cyst was 35 [IQR = 47-25] mm. All 48 patients underwent excision of cyst with Roux-en-Y hepaticojejunostomy, and eight underwent resection with hepaticoduodenostomy. Six patients underwent liver resection, and five patients underwent orthotopic liver transplantation. Malignancy was concomitant in five adult patients, being identified on preoperative imaging in three cases; and atypia was seen in three additional patients. Early morbidity included Clavien-Dindo classification grades III (n = 7) and II (n = 5), while long-term complications consisted of Clavien-Dindo grades V (n = 5), IV (n = 2), III (n = 18), and II (n = 1).
Conclusions:
Presentation and management of choledochal cyst is varied. Malignant transformation is often detected incidentally, and so should be the driving source for resection when a choledochal cyst is diagnosed.
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