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Choledochal Cyst Excision in Infants-A Retrospective Study
Adam Kowalski1, Grzegorz Kowalewski1, Piotr Kaliciński1
1Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, 04-730 Warsaw, Poland.
Insights
Early surgical intervention for choledochal cysts (CC) in infants is safe and effective. Laparoscopic surgery in children under one year of age leads to excellent outcomes with fewer complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Malformations
Background:
- Choledochal cysts (CC) are rare congenital biliary tract malformations predominantly diagnosed in children.
- Surgical excision with Roux-en-Y hepaticojejunostomy is the definitive treatment for CC.
- The optimal timing for surgical intervention, particularly in asymptomatic neonates, remains debated.
Purpose of the Study:
- To evaluate the outcomes of early surgical intervention for choledochal cysts in infants.
- To compare complication rates between symptomatic and asymptomatic infants undergoing CC surgery.
- To assess the impact of surgical approach (laparotomy vs. laparoscopy) on late postoperative outcomes.
Main Methods:
- Retrospective review of 256 pediatric patients who underwent CC excision between 1984 and 2021.
- Focus on a subgroup of 59 patients operated on before one year of age.
- Analysis of preoperative symptoms, surgical approach, and late postoperative complications.
Main Results:
- 38% of infants were asymptomatic preoperatively, while 62% presented with symptoms.
- Overall, 76% of patients had an uneventful late postoperative course.
- Symptomatic patients experienced a 16% complication rate, compared to 4% in asymptomatic patients. Laparoscopic surgery showed no late complications, unlike laparotomy (17%).
Conclusions:
- Early surgical treatment of choledochal cysts in infants is associated with excellent early and long-term results.
- Prompt intervention can prevent the development of preoperative complications.
- Minimally invasive laparoscopic surgery appears to be associated with a lower risk of late postoperative complications in this pediatric population.
Abstract:
A choledochal cyst is a rare malformation primarily diagnosed in children. The only effective therapy remains surgical cyst resection followed by Roux-en-Y hepaticojejunostomy. Treating asymptomatic neonates remains a point of discussion. Between 1984 and 2021, we performed choledochal cyst (CC) excision in 256 children at our center. Out of this group, we retrospectively reviewed the medical records of 59 patients who were operated on under one year of age. Follow-up ranged from 0.3 to 18 years (median 3.9 years). The preoperative course was asymptomatic in 22 (38%), while 37 patients (62%) had symptoms before surgery. The late postoperative course was uneventful in 45 patients (76%). In symptomatic patients, 16% had late complications, while in asymptomatic patients, only 4%. Late complications were observed in the laparotomy group in seven patients (17%). We did not observe late complications in the laparoscopy group. Early surgical intervention is not followed by a high risk of complications and may prevent the onset of preoperative complications, giving excellent early and long-term results, especially after minimally invasive laparoscopic surgery.
