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Optimal timing of surgery for prenatally diagnosed choledochal cysts
In Geol Ho1, Kyong Ihn1, Ho Jong Jeon2
1Division of Pediatric Surgery, Department of Surgery, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Republic of Korea.
Insights
Early surgery for prenatally diagnosed choledochal cysts in infants led to longer hospital stays and diet resumption times. However, postponing surgery for asymptomatic infants until 4 months or 7kg showed comparable liver function recovery and fewer complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Choledochal cysts are increasingly diagnosed before birth.
- The timing of surgical intervention significantly impacts treatment outcomes for choledochal cysts.
Purpose of the Study:
- To compare clinical outcomes of prenatally diagnosed choledochal cysts in infants based on surgical treatment timing.
Main Methods:
- Retrospective review of medical records for infants with antenatally diagnosed choledochal cysts who underwent surgery.
- Analysis of demographic data, cyst type, liver enzymes, and surgical outcomes stratified by intervention timing.
Main Results:
- Infants undergoing early surgery (before 30 days) had longer diet resumption times and hospital stays compared to those with late surgery.
- Two complications occurred in the early surgery group; minimally invasive surgery was more common in the late surgery group.
- Postoperative liver function recovered similarly in both groups by 6 months.
Conclusions:
- Early surgical intervention for asymptomatic prenatally diagnosed choledochal cysts is associated with poorer short-term outcomes.
- Postponing surgery for asymptomatic infants until 4 months of age or 7kg is recommended.
- Close monitoring of asymptomatic infants is advised while awaiting optimal surgical timing.
Objective:
Choledochal cysts are increasingly being diagnosed antenatally. The appropriate time of surgical treatment has the greatest impact on the prognosis of choledochal cyst treatment. The purpose of this study was to compare the clinical outcomes of prenatally diagnosed choledochal cysts in infants according to the surgical treatment timing.
Methods:
We retrospectively reviewed the medical records of infants who underwent surgery for choledochal cysts with antenatal diagnoses. We investigated each patient's demographic information, type of choledochal cyst, serum liver enzyme levels, and surgical outcomes according to the surgical intervention timing.
Results:
Between May 2006 and December 2020, 93 infants underwent surgery to treat choledochal cysts; among them, 68 had antenatally suspected choledochal cysts. Of the 68 patients, 21 developed symptoms directly after birth. While 38 patients remained asymptomatic, 9 developed symptoms before operation. To compare surgical outcomes, asymptomatic patients were divided into early (13 cases) and late (25 cases) operation groups based on an age benchmark of 30 days. The early surgical group experienced longer times to resume a full diet (6.0 ± 1.6 vs. 4.5 ± 0.7, p < 0.001) and longer postoperative hospital stays (11 ± 3.9 vs. 7.5 ± 0.8, p < 0.001). Surgical complications occurred in two patients in the early operation group. Minimally invasive surgery was performed in 12 patients in the late operation group. In both groups, postoperative liver function recovered at 6 months, with no significant difference.
Conclusion:
The results of this study showed longer hospital stays, increased diet durations, and postoperative complications in early surgery patients. However, liver function recovery was not different between the early and late operation groups. Thus, asymptomatic patients should be closely monitored, and we recommend that definitive surgical intervention be postponed until 4 months of age or until weight reaches 7 kg.
