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Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Timing of surgery for symptomatic choledochal cysts with hyperamylasemia in children: a retrospective analysis
Ruyue Gao1, Xin Ding2, Wei Chen1
1Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China.
Insights
Timing of surgery for choledochal cyst (CDC) with hyperamylasemia in children does not impact outcomes. Early surgical intervention is recommended when the patient is stable, as delaying surgery offers no therapeutic benefit.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Research
Background:
- Choledochal cysts (CDCs) are congenital biliary tract malformations.
- Hyperamylasemia in pediatric CDC patients indicates active inflammation.
- Optimal surgical timing for symptomatic CDC with hyperamylasemia remains debated.
Purpose of the Study:
- To determine the optimal surgical timing for pediatric patients diagnosed with symptomatic choledochal cysts (CDC) and hyperamylasemia.
- To compare surgical outcomes between patients operated on during symptomatic phase versus remission phase.
Main Methods:
- Retrospective review of 61 pediatric patients with symptomatic CDC and hyperamylasemia.
- Patients underwent cyst excision and Roux-en-Y hepaticojejunostomy.
- Comparison of outcomes between symptomatic and remission surgical groups.
Main Results:
- No significant differences in conversion rates, biliary fistulas, or pancreatitis between symptomatic and remission groups.
- Hospital stays were comparable, but costs were higher in the symptomatic group.
- Pathological inflammation severity was similar in both groups.
Conclusions:
- Postponing surgery for pediatric CDC with hyperamylasemia until symptom remission offers no therapeutic advantage.
- Early surgical intervention should be considered when the patient's general condition permits.
- This finding supports timely surgical management for pediatric CDCs.
Purpose:
This study aims to investigate the optimal surgical timing for symptomatic choledochal cyst (CDC) with hyperamylasemia in children.
Methods:
We retrospectively reviewed 61 symptomatic CDC patients with hyperamylasemia who underwent cyst excision and Roux-en-Y hepaticojejunostomy between July 2020 and November 2021. Patients were either in symptomatic phase or in remission at the time of surgery.
Results:
Thirty-seven patients were assigned to the symptomatic group and 24 to the remission group, with no significant difference in conversion rates (5.4% vs. 4.2%, P = 1.000). In the symptomatic group, two patients (5.4%) developed biliary fistulas, and two (5.4%) experienced pancreatitis. In the remission group, one patient (4.2%) had active bleeding, and one (4.2%) developed a biliary fistula without statistically significant difference (P = 1.000). The median total, preoperative, and postoperative hospital stays were comparable between the groups (P = 0.411, P = 0.159, and P = 0.731, respectively). However, costs were higher in the symptomatic group (P = 0.043). The two groups exhibited similar pathological inflammation severity (P = 0.065).
Conclusion:
Postponing surgery until symptom remission demonstrates no therapeutic advantage for children with CDC and hyperamylasemia. Early surgery should be considered, provided that the general condition of the patient permits.
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