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Recent experience with choledochal cyst
Insights
Choledochal cyst treatment in children shows cyst excision is the preferred method. This surgical approach, whether primary or secondary, leads to better outcomes compared to other procedures for choledochal cysts.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Choledochal cysts are congenital dilations of the bile ducts.
- Presentation varies, with infantile cases mimicking biliary atresia and later-onset cases presenting with pain, mass, or jaundice.
Purpose of the Study:
- To evaluate the long-term outcomes of different surgical treatments for choledochal cysts in pediatric patients.
Main Methods:
- Retrospective review of 17 patients (newborn to 17 years) treated for choledochal cysts over 11 years.
- Analysis of surgical procedures including cystoduodenostomy, Roux-Y cystojejunostomy, and cyst excision with hepaticojejunostomy.
Main Results:
- Cyst excision, primary or secondary, with Roux-Y hepaticojejunostomy yielded excellent results in all patients (n=9).
- Cystoduodenostomy (n=2) and Roux-Y cystojejunostomy (n=6) required revisions in some cases.
- Infantile group (n=17, mean age 3 months) presented with obstructive jaundice; late-onset group (n=17, mean age 9 years) presented with pain, mass, and jaundice.
Conclusions:
- Cyst excision is the recommended primary or secondary treatment for choledochal cysts.
- Specific approaches like hepatic lobectomy for Caroli's disease and cyst unroofing for choledochocele are indicated based on anatomy.
Abstract:
This report details an 11-year experience with 17 patients ranging from newborn to 17 years with choledochal cyst. Two distinct groups were noted: an infantile group (mean age: 3 months) with obstructive jaundice identical to biliary atresia and a late onset group (mean age: 9 years) with various combinations of pain, mass, and jaundice. Two patients had cystoduodenostomy performed and both required revision. One of six patients who had Roux-Y cystojejunostomy required revision. All seven patients who had primary cyst excision and two patients who had secondary cyst excision with Roux-Y hepaticojejunostomy have been followed prospectively and have done well. The follow-up period ranges from 1-11 years with an average of 5.8 years. Cyst excision should be performed as a primary or secondary procedure whenever feasible. The rare patients with intrahepatic ductal dilatation (Caroli's disease) are best approached by hepatic lobectomy when possible, and those with choledochocele should be treated by unroofing the cyst as indicated by the anatomy encountered.