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Updated: Nov 8, 2025
Application of Laparoscopic Ultrasonography in Primary Choledochal Suture during Combined Two-lens Surgery
Published on: March 28, 2025
Ultrasonography is useful in differentiating between cystic biliary atresia and choledochal cyst
Pu Yu1, Ning Dong2, Yong Kang Pan1
1Department of Neonatal Surgery, Xian Childrens Hospital, Xian, Shaanxi, China.
Insights
Ultrasonography can differentiate between cystic biliary atresia (CBA) and choledochal cyst (CC) in infants. Key indicators include cyst volume changes and gallbladder size, aiding in early diagnosis and management of biliary cystic malformations.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Hepatobiliary Medicine
Background:
- Biliary cystic malformation (BCM) diagnosis is increasing with ultrasonography (US).
- Cystic biliary atresia (CBA) and choledochal cyst (CC) present similar US features but require different management.
- Distinguishing CBA from CC prenatally is crucial for appropriate care.
Purpose of the Study:
- To evaluate the efficacy of ultrasonography (US) in differentiating cystic biliary atresia (CBA) from choledochal cyst (CC).
- To identify specific US markers that distinguish CBA from CC in neonates and infants.
Main Methods:
- Retrospective analysis of clinical data from 98 BCM patients under 130 days old.
- Patients were classified into CBA and CC groups based on intraoperative cholangiography.
- Ultrasonographic features, including cyst volume, gallbladder size, and the triangular cord sign, were analyzed.
Main Results:
- Cyst volume remained stable in CBA but increased postnatally in CC.
- Atrophic gallbladder was observed in 23/31 CBA patients, but none with CC (P < 0.001).
- The triangular cord sign was present in 10/31 CBA patients and absent in all CC patients (P < 0.001).
Conclusions:
- Serial prenatal and postnatal US can differentiate most cases of CBA from CC.
- These US findings facilitate improved prenatal counseling and postnatal management strategies.
- Ultrasonography is a valuable tool for distinguishing between CBA and CC in BCM.
Purpose:
With the advent of ultrasonography (US), perinatal diagnosis of biliary cystic malformation (BCM) has become more prevalent. BCM includes cystic biliary atresia (CBA) and choledochal cyst (CC). Both share similar ultrasonographic features and clinical manifestations, and yet the postnatal management is very different. This study was to assess whether CBA can be distinguished from CC by US.
Methods:
We retrospectively studied the clinical data of 98 BCM patients aged less than 130 days between January 2013 and November 2015. The patients were divided into the CBA group and the CC group based on intraoperative cholangiography. The ultrasonographic features in each group were then analyzed.
Results:
Thirty-one children had CBA (type I: 24, type III: 7) and 67 children had CC (all: type I). The cyst volume did not show a significant change in the CBA group while the cyst volume increased postnatally in the CC group. Preoperative cyst volume can be used as a sensitive indicator to distinguish choledochal cyst from cystic biliary atresia. Gallbladder size in the two groups differed significantly (P = 0.034); 23 of 31 patients in the CBA group had atrophic gallbladder, whereas none of the patients in the CC group had atrophic gallbladder (P < 0.001). The triangular cord sign was detected in ten patients in the CBA group and in none of the patients in the CC group (P < 0.001).
Conclusion:
Serial prenatal and postnatal ultrasonographic studies may help differentiate CBA from CC in the majority of BCM, facilitating prenatal counseling and postnatal management.
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