[Choledocal cyst. Surgical treatment]

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Hepatobiliary Surgery

Context:

• Choledochal cysts are congenital biliary tract abnormalities with a significant incidence in certain regions.
• Management of choledochal cysts involves surgical intervention to prevent complications like cholangitis, pancreatitis, and malignancy.
• Previous surgical techniques have included cystoduodenostomy and cystojejunostomy, each with varying outcomes.

Purpose:

• To review surgical outcomes for choledochal cysts at Hospital del Niño IMAN.
• To compare the efficacy and safety of cystoduodenostomy versus Roux-en-Y cystojejunostomy.
• To highlight the incidence of choledochal cysts and discuss surgical management strategies.

Summary:

• A retrospective review of 13 patients (3 months to 13 years) with choledochal cysts treated with either cystoduodenostomy (7 patients) or Roux-en-Y cystojejunostomy (6 patients).
• Two deaths occurred in the cystoduodenostomy group, attributed to pre-existing hepatic lesions, not the surgery itself.
• The Roux-en-Y cystojejunostomy group experienced no mortality, with all patients remaining asymptomatic from 6 months to 5 years post-surgery.
• Disadvantages of cystoduodenostomy, such as biliary reflux, were noted, and the potential benefits of complete cyst resection were considered.

Impact:

• Roux-en-Y cystojejunostomy demonstrates superior outcomes in choledochal cyst management compared to cystoduodenostomy.
• Findings emphasize the need for careful surgical technique selection in treating pediatric choledochal cysts.
• The study underscores the high incidence of choledochal cysts in the region and informs clinical practice regarding optimal surgical approaches.