Choledochal Cyst / Biliary
Also covered as: choledochal cyst · cholangitis · pancreatitis · cystic biliary atresia · cholangiocarcinoma · Caroli's disease · biliary ascites · anastomotic stricture
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Fundamentals
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Choledochal Cyst Podcast
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In this podcast, Dr. Alex Bondoc and Dr. Rae Hanke discuss the intricacies of choledochal cysts. Contributing editor: Dr. Rod Gerardo.Choledochal Cyst- Definition: Congenital cystic dilation of the biliary tree- Epidemiology: We
podcast22:07 · Dec 2020
Choledochal Cysts: In Brief with Dr. Alexander Bondoc
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Are you having difficulty keeping the 5 types of choledochal cyst straight? Each has unique anatomy and management principles. Join Dr. Alexander Bondoc in an overview of Choledochal Cysts for the surgical trainee.
podcast16:55 · May 2022
Evidence & Research
3 items
Outcomes of laparoscopic versus open resection of pediatric choledochal cyst
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"Outcomes of laparoscopic versus open resection of pediatric choledochal cyst"
Ramsey et al, Journal of Pediatric Surgery
https://www.jpedsurg.org/article/S0022-3468(22)00799-0/fulltext
Video: Ellen Encisco
video0:54 · May 2023
Journal of pediatric surgery Article Review: April 2023, IPEG issue
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We’re featuring Journal of Pediatric surgery articles to bring you some of the latest news!
This week we are discussing three articles from the April 2023 issue, the IPEG issue with editor Dr. Mark Wulkan and authors Drs. Luzia Toselli,
podcast13:22 · Jul 2023
Quick Literature Updates Episode 15
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We’re back with fifteenth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most inte
video4:12 · Jan 2024
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Choledochal cyst resection with biliary reconstruction remains the definitive treatment, with ongoing debate regarding optimal anastomotic technique and surgical approach. Meta-analysis demonstrates no significant difference in cholangitis incidence between hepaticoduodenostomy and hepaticojejunostomy [e2936-c12, e6861-c12], though some advocate Roux-en-Y reconstruction for reduced bile reflux [e2936-c11, e6861-c11]. Hepaticoduodenostomy offers shorter operative time and decreased fat malabsorption without increased biliary leak risk [e2936-c14, e6861-c14]. Laparoscopic resection yields shorter hospital stays, fewer complications, and lower costs compared to open surgery [e6640-c5, e6640-c6, e6640-c7], with laparoscopic cases more commonly receiving hepaticoduodenostomy [e6640-c4, e7927-c9]. Technical innovations include double hemicircumferential running suture (mean operative time 2.95 hours, mean blood loss 9.05 mL, zero anastomotic complications in 218 patients) [e4122-c11, e4122-c12, e4122-c14, e4122-c15, e4122-c16] and robotic-assisted anastomosis [e2936-c6, e6861-c6]. Giant cysts can be managed laparoscopically via intraoperative aspiration after initial trocar placement [e8465-c22, e8465-c24]. Malignant transformation occurs in approximately 8% of patients by ages 40–60 , with higher risk in those operated after age 5 [e8465-c33, e8465-c34].
- Hepaticoduodenostomy and hepaticojejunostomy show equivalent cholangitis rates and overall complication profiles, though reconstruction choice often correlates with surgical approach. [e2936-c12, e2936-c13, e6861-c12, e6861-c13]
- Laparoscopic resection demonstrates shorter length of stay, fewer complications, and lower costs versus open surgery in national database analysis of 577 pediatric cases. [e6640-c5, e6640-c6, e6640-c7]
- Double hemicircumferential running suture technique in 218 laparoscopic cases achieved zero anastomotic stenosis, fistula, or cholangitis with mean operative time under 3 hours. [e4122-c11, e4122-c14, e4122-c15, e4122-c16]
- Giant choledochal cysts are amenable to laparoscopic excision via intraoperative aspiration after initial trocar placement, avoiding need for preoperative drainage which risks cholangitis. [e8465-c21, e8465-c22, e8465-c24]
- Malignant transformation cumulative incidence reaches 8% by ages 40–60, predominantly in patients operated after age 5; close surveillance warranted for late-operated cohorts. [e8465-c27, e8465-c33, e8465-c35]
For patients & families
A choledochal cyst is an abnormal ballooning of the bile duct — the tube that carries digestive fluid from the liver [e2823-c1, e2936-c2]. Doctors often find these cysts when a child has belly pain, and imaging tests like ultrasound or MRI show the widened duct [e2936-c1, e2936-c2]. The standard treatment is surgery to remove the cyst and reconnect the healthy bile ducts to the intestine so bile can flow normally [e2936-c3, e2936-c5]. Surgeons can perform this operation through small incisions (laparoscopic) or with robotic assistance, and most children recover well — typically eating regular food within a few days and going home within a week [e2936-c7, e2936-c8, e2936-c9, e6640-c2]. Studies show that laparoscopic surgery often means shorter hospital stays and fewer complications compared to traditional open surgery [e6640-c5, e6640-c6]. There are different ways to reconnect the bile ducts, and research suggests both main techniques are safe and effective [e2936-c12, e2936-c13]. Children who have the surgery usually do well long-term, with no further belly pain or weight problems at follow-up visits .
A choledochal cyst is an abnormal ballooning of the bile duct — the tube that carries digestive fluid from the liver [e2823-c1, e2936-c2]. Doctors often find these cysts when a child has belly pain, and imaging tests like ultrasound or MRI show the widened duct [e2936-c1, e2936-c2]. The standard treatment is surgery to remove the cyst and reconnect the healthy bile ducts to the intestine so bile can flow normally [e2936-c3, e2936-c5]. Surgeons can perform this operation through small incisions (laparoscopic) or with robotic assistance, and most children recover well — typically eating regular food within a few days and going home within a week [e2936-c7, e2936-c8, e2936-c9, e6640-c2]. Studies show that laparoscopic surgery often means shorter hospital stays and fewer complications compared to traditional open surgery [e6640-c5, e6640-c6]. There are different ways to reconnect the bile ducts, and research suggests both main techniques are safe and effective [e2936-c12, e2936-c13]. Children who have the surgery usually do well long-term, with no further belly pain or weight problems at follow-up visits .
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Outcomes of laparoscopic versus open resection of pediatric choledochal cyst
The study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018.
epidemiologicalEllen Encisco0:13 ↗
The majority of patients underwent open resection.
epidemiologicalEllen Encisco0:24 ↗
Patients who underwent open resection were more likely to have a Roux-en-Y hepaticojejunostomy.
clinicalEllen Encisco0:24 ↗
Patients who underwent laparoscopic resection were more likely to have a hepaticoduodenostomy.
clinicalEllen Encisco0:24 ↗
Patients who underwent open resection were more likely to have a longer length of hospital stay.
clinicalEllen Encisco0:39 ↗
Patients who underwent open resection were more likely to have more complications.
clinicalEllen Encisco0:39 ↗
Patients who underwent open resection had higher total costs.
clinicalEllen Encisco0:39 ↗
Quick Literature Updates Episode 15
The Hirschsprung-associated IBD study was retrospective, gathering patients from 2000 to 2021 at 17 institutions
epidemiologicalCecilia Gigena0:59 ↗
The study identified 55 Hirschsprung patients, with 50% having long segment disease
epidemiologicalCecilia Gigena1:14 ↗
68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis
epidemiologicalCecilia Gigena1:19 ↗
10% of the Hirschsprung patients had trisomy 21
epidemiologicalCecilia Gigena1:19 ↗
Long segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 are potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through
clinicalCecilia Gigena1:19 ↗
The choledochal cyst study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018
epidemiologicalEllen Encisco2:11 ↗
The majority of choledochal cyst patients underwent open resection
epidemiologicalEllen Encisco2:21 ↗
Patients who underwent open choledochal cyst resection were more likely to have a Roux-en-Y hepaticojejunostomy
clinicalEllen Encisco2:21 ↗
Patients who underwent laparoscopic choledochal cyst resection were more likely to have a hepaticoduodenostomy
clinicalEllen Encisco2:21 ↗
Patients who underwent open choledochal cyst resection had longer length of hospital stay compared to laparoscopic resection
clinicalEllen Encisco2:36 ↗
Patients who underwent open choledochal cyst resection had more complications compared to laparoscopic resection
clinicalEllen Encisco2:36 ↗
Patients who underwent open choledochal cyst resection had higher total costs compared to laparoscopic resection
clinicalEllen Encisco2:36 ↗
The solid organ injury study was retrospective and conducted in South Carolina
epidemiologicalCecilia Gigena3:09 ↗
The study gathered 262 patients with isolated solid organ injuries, grades 1 to 3
epidemiologicalCecilia Gigena3:19 ↗
148 patients had solid organ injuries grades 1 or 2, and none required acute intervention
clinicalCecilia Gigena3:26 ↗
Of 114 patients with grade 3 solid organ injuries, only 3 required acute intervention
clinicalCecilia Gigena3:34 ↗
Isolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the emergency department
clinicalCecilia Gigena3:44 ↗
Journal of pediatric surgery Article Review: April 2023, IPEG issue
The Titanic Index measures the percentage of sternum that lies under the anterior costal line
clinicalLuzia Toselli2:00 ↗
The study included 78 patients between 2020 and 2022, with 47% receiving two bars and 53% receiving more than two bars
clinicalLuzia Toselli2:12 ↗
A Titanic Index cutpoint of 66.5% predicted need for more than two implants with 93% sensitivity and 92% specificity
clinicalLuzia Toselli3:00 ↗
Severe outcomes in button battery ingestion were defined as deep mucosal erosion, perforation, mediastinitis, vascular or airway injury or fistula, and development of esophageal stricture
clinicalEllen Encisco5:36 ↗
The Boston study included 143 patients under 21 years old from 2008 to 2021, with 24 having severe outcomes
epidemiologicalEllen Encisco6:05 ↗
Three predictive factors for severe button battery outcomes were: presence in esophagus at presentation, two centimeter or larger battery size, and presence of any symptoms
clinicalEllen Encisco6:20 ↗
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