Choledochal cysts in adults: clinical management

Area of Science:

• Hepatobiliary Surgery
• Surgical Gastroenterology

Background:

• Choledochal cysts (CCs) are congenital biliary dilations, often presenting with complex hepatobiliary pathologies in adults.
• Adult presentations of CCs involve more frequent and severe coexistent conditions than in children.

Purpose of the Study:

• To review clinicopathologic features and long-term outcomes of surgical management in adults with choledochal cysts.
• To identify factors influencing postoperative results and treatment success.

Main Methods:

• Retrospective review of 29 adult patients undergoing surgical management for choledochal cysts.
• Analysis of clinicopathologic data, operative approaches, and long-term postoperative outcomes (mean 9.1 years).

Main Results:

• Common symptoms included abdominal pain, jaundice, and cholangitis.
• Frequent coexistent pathologies: cystolithiasis/cholelithiasis, pancreatitis (33%), malignancy (28%), cirrhosis, and intrahepatic abscess.
• Cyst excision yielded excellent results in 5/7 patients with type I/IVA cysts, while cystenterostomy was excellent in only 7/19.

Conclusions:

• Adult choledochal cysts present with significant coexistent pathologies, impacting surgical outcomes.
• Cyst excision with Roux-en-Y hepaticojejunostomy is the recommended treatment of choice for adults.
• This approach aims to prevent pancreatitis through pancreaticobiliary disconnection and potentially reduce malignancy risk.