Choledochal cyst

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Pediatric Surgery
• Surgical Oncology

Background:

• Congenital biliary dilatation (choledochal cyst) is a rare condition with a predilection for East Asian females, often associated with pancreaticobiliary malunion (PBMU).
• Early diagnosis is crucial due to the significant risk of malignancy developing within the cyst or intrahepatic bile ducts.
• Complete excision and Roux-en-Y hepaticoenterostomy are the standard surgical treatments, achievable via open or minimally invasive approaches.

Purpose of the Study:

• To highlight the importance of early diagnosis and surgical management of choledochal cysts.
• To present advanced surgical techniques and a novel classification system for choledochal cysts.
• To discuss the management strategies employed at Juntendo, focusing on reducing post-operative complications.

Main Methods:

• Surgical management involving complete choledochal cyst excision and Roux-en-Y hepaticoenterostomy.
• Minimally invasive techniques including laparoscopy and robotic assistance, guided by principles of open surgery.
• Innovative intraoperative tools: endoscopy for common channel inspection and indocyanine green fluorescence imaging for tissue plane visualization.
• Development of a PBMU-based classification system for choledochal cysts.

Main Results:

• Current surgical management demonstrates reduced early and late complications, including anastomotic leakage, cholangitis, stricture, and cholangiocarcinoma.
• Intraoperative endoscopy effectively clears debris, minimizing risks of post-operative pancreatitis and stone formation.
• Near infra-red fluorescence enhances surgical precision, particularly in minimally invasive procedures.
• The new classification system addresses inconsistencies in existing systems and aligns better with clinical presentations.

Conclusions:

• Early surgical intervention for choledochal cysts significantly reduces the risk of malignancy and improves long-term outcomes.
• Advanced surgical techniques and intraoperative adjuncts enhance safety and efficacy, lowering complication rates.
• A novel classification system based on PBMU provides a more consistent framework for managing choledochal cysts.