Long-term follow-up after choledochal cyst excision in children

Choledochal cyst (CC) excision is indicated to avoid complications. There is no consensus on postoperative follow-up investigations, duration, or timing. At our institution, patients are followed for 5 years after CC excision with ultrasound and liver laboratory tests. We aimed to evaluate both the post-operative outcomes after pediatric CC excision, focusing on long-term complications, and the adherence to our postoperative follow-up protocol.

A retrospective chart review of children who underwent a CC excision at our institution between January 1986 and March 2025 was performed. Complications occurring later than 5 years after surgery were defined as late complications. Comparisons were made between management eras (early: 1986-2001 vs. modern: 2002-2025). p < 0.05 was considered significant.

While 57 children underwent CC excision, 49 (86 %) had postoperative follow-up and were included in outcomes analyses. Median follow-up duration for the entire cohort was 2.4 years (34 days-16.2 years). Out of 50 patients who had undergone surgery over 5 years ago, 22 patients were followed for of at least 5 years (overall adherence to our institutional postoperative follow-up protocol: 44 %). Median follow-up for these 22 patients was 12.0 years (5.4-16.2). Eight patients (8/22, 36 %) suffered from late complications. Additionally, 8 patients were transitioned to an adult provider.

While most patients have good long-term outcomes after pediatric CC excision, major complications can still occur later than five years after surgery. Studies focusing on late outcomes, including after transition to adult care, are needed to determine the optimal long-term surveillance after childhood CC excision.

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