Surgical aspects of choledochal cyst in children and adults: an experience of 106 cases
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In brief
In brief
This retrospective study of 106 choledochal cyst cases compares clinical presentation and outcomes between pediatric and adult patients. Adults experienced significantly higher rates of postoperative complications including strictures, stones, and cholangitis, requiring more interventions than children, supporting early definitive surgical management.
- Abdominal pain is the predominant symptom in both children and adults with choledochal cyst, occurring in 87% of adults vs 53% of children.
- Adults experience significantly more postoperative complications (26.4% vs 5.7%) including stones, strictures, and cholangitis compared to children.
- Ultrasound remains the preferred initial screening modality for choledochal cyst diagnosis, used in 75.5% of cases in this series.
- Cyst excision with roux-en-y hepatico-jejunostomy is the standard surgical approach, performed in 88.7% of cases with type I cysts most common.
- Early definitive surgery is recommended to prevent long-standing inflammation that contributes to higher complication rates seen in adult patients.
Written by the GCMD Library team from the article.
Abstract
Purpose
To describe clinical features of choledochal cyst (CC) patients in terms of demographic data, clinical presentation, investigations, treatment, and outcomes among children and adults.
Methods
The medical records of patients undergoing choledochal cyst (CC) surgery from 2002 to 2021 at a university hospital were retrospectively reviewed. The patients were divided into two groups: children (< 15 years) and adults (≥ 15 years). Descriptive statistics were used.
Results
There were 106 cases of CC (Female/male = 88/18, children/adult = 53/53). Abdominal pain was the predominant presenting symptom, followed by jaundice in both groups. Adults were significantly more prone to present with abdominal pain compared to children (86.8% vs. 52.8%; p < 0.001), while children were more likely to experience acholic stool than adults (22.6% vs. 3.8%; p = 0.004). Ultrasound was the preferred investigation screening modality (75.5%). Most patients were presented with type I CC (71.7%). Laparoscopic-assisted approach was performed in 8.5%. CC excision with roux-en-y hepatico-jejunostomy was the main procedure (88.7%). Adults had a higher incidence of post-op complications, including stones, anastomosis stricture, abdominal collection, and cholangitis. Adults were significantly more likely to require intervention after surgery, compared to children (26.4% vs. 5.7%; p = 0.04).
Conclusions
Ultrasound was the most common screening tool for diagnosis. Postoperatively, adults with CC experience more serious post-op complications compared to children. This could be attributed to long-standing cystic inflammation. Therefore, prompt definitive surgery is recommended for CC patients.