# Choledochal Cyst — GCMD Library living collection

Everything in the library about choledochal cyst — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 102 cited statements

## Episodes
### Fundamentals
- [Choledochal Cysts: In Brief with Dr. Alexander Bondoc](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439) — podcast · 16:55 · [machine version](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439.md)

### Evidence & Research
- [Outcomes of laparoscopic versus open resection of pediatric choledochal cyst](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640) — video · 0:54 · [machine version](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640.md)

### In-Depth Reviews
- [Choledochal Cyst Podcast](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310) — podcast · 22:07 · [machine version](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=0) Definition, Epidemiology, and Etiology of Choledochal Cysts (Ep 1)
- [2:01](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=121) Tadani Classification of Choledochal Cysts (Ep 1)
- [3:20](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=200) Clinical Presentation and Differential Diagnosis (Ep 1)
- [5:41](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=341) Diagnostic Workup (Ep 1)
- [7:53](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=473) Indications for Surgery and Malignancy Risk (Ep 1)
- [11:08](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=668) Surgical Goals and Type-Specific Approaches (Ep 1)
- [13:16](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=796) Surgical Technique for Type 1 and 4 Cysts (Ep 1)
- [18:40](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1120) Postoperative Management and Long-Term Outcomes (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=0) Introduction and epidemiology of choledochal cysts (Ep 2)
- [1:14](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=74) Todani classification, etiology, and diagnostic workup (Ep 2)
- [7:23](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=443) Indications for surgery and treatment goals (Ep 2)
- [12:08](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=728) Type-specific surgical techniques and reconstruction (Ep 2)
- [16:12](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=972) Postoperative management and long-term follow-up (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=0) Study overview: open vs laparoscopic choledochal cyst resection (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018." — Ellen Encisco (epidemiological) [Ep 3 · 0:13](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=13)
- "The majority of patients underwent open resection." — Ellen Encisco (epidemiological) [Ep 3 · 0:24](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=24)
- "Patients who underwent open resection were more likely to have a Roux-en-Y hepaticojejunostomy." — Ellen Encisco (clinical) [Ep 3 · 0:24](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=24)
- "Patients who underwent laparoscopic resection were more likely to have a hepaticoduodenostomy." — Ellen Encisco (clinical) [Ep 3 · 0:24](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=24)
- "Patients who underwent open resection were more likely to have a longer length of hospital stay." — Ellen Encisco (clinical) [Ep 3 · 0:39](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=39)
- "Patients who underwent open resection were more likely to have more complications." — Ellen Encisco (clinical) [Ep 3 · 0:39](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=39)
- "Patients who underwent open resection had higher total costs." — Ellen Encisco (clinical) [Ep 3 · 0:39](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=39)
- "Choledochal cyst is a congenital cystic dilation of the biliary tree." — Alex Bondoc (clinical) [Ep 1 · 0:29](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=29)
- "Incidence of choledochal cysts in the Western world is about 1 in 100,000." — Alex Bondoc (epidemiological) [Ep 1 · 0:36](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- "In Eastern Asia, choledochal cyst incidence is 1 in 13,000." — Alex Bondoc (epidemiological) [Ep 1 · 0:36](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- "Choledochal cysts are three to four times more likely in females than in males." — Alex Bondoc (epidemiological) [Ep 1 · 0:36](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- "There is no genetic predisposition to choledochal cysts, but some genes including PKD1 have been identified in limited studies for type 5 choledochal cysts." — Alex Bondoc (clinical) [Ep 1 · 0:36](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- "The most common classification system for choledochal cysts was developed by a surgeon named Tadani in Japan and includes five types." — Alex Bondoc (clinical) [Ep 1 · 1:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- "For types 1 and 4 choledochal cysts, the etiology is likely embryologic, relating to pancreaticobiliary duct junction (pancreaticobiliary malunion), which creates a long common channel of the pancreaticobiliary duct." — Alex Bondoc (clinical) [Ep 1 · 1:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- "Reflux of pancreatic enzymes from the head of the pancreas back into the biliary tree causes inflammation, degeneration, and epithelial changes in types 1 and 4 choledochal cysts." — Alex Bondoc (clinical) [Ep 1 · 1:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- "In type 5 choledochal cysts, genetic mutation might predispose to more diffuse dilation of both the intra- and extrahepatic biliary trees." — Alex Bondoc (clinical) [Ep 1 · 1:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- "Type 1 choledochal cyst is a dilation of the extrahepatic common bile duct only, which can be fusiform or saccular." — Alex Bondoc (clinical) [Ep 1 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "Type 2 choledochal cyst is a small diverticulum off of the common bile duct." — Alex Bondoc (clinical) [Ep 1 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "Type 3 choledochal cyst is a choledochocele affecting the portion of the common bile duct in the wall of the duodenum." — Alex Bondoc (clinical) [Ep 1 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "Type 4a choledochal cyst consists of multiple cysts in both the intra- and extrahepatic biliary tree." — Alex Bondoc (clinical) [Ep 1 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "Type 4b choledochal cyst consists of multiple cysts in the extrahepatic biliary tree only." — Alex Bondoc (clinical) [Ep 1 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "Type 5 choledochal cyst is intrahepatic only and diffusely throughout, called Caroli's disease, which can be diffuse or limited to one lobe or one hemi-liver." — Alex Bondoc (clinical) [Ep 1 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "In younger children such as infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound for other causes." — Alex Bondoc (clinical) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "In children, choledochal cysts often present with symptoms consistent with cholangitis, such as jaundice or fever." — Alex Bondoc (clinical) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "Patients with choledochal cysts can have a palpable right upper quadrant mass." — Alex Bondoc (clinical) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "The triad of jaundice, fever, and palpable right upper quadrant mass (Charcot's triad) is incredibly uncommon as a presentation of choledochal cysts." — Alex Bondoc (clinical) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "Giant choledochal cysts in small children can perforate and present with biliary ascites." — Alex Bondoc (clinical) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "Giant choledochal cysts can be diagnosed prenatally on week 20 ultrasounds." — Alex Bondoc (clinical) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "Prenatally diagnosed choledochal cysts require fetal consultation at a fetal surgery center for establishment of care and counseling, because cystic biliary atresia must be ruled out postnatally." — Alex Bondoc (guideline) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "A recent citation demonstrated that if a choledochal cyst was diagnosed prenatally and was larger than 4.5 centimeters at the 20-week anatomy scan, there was a higher rate of postnatal symptomatology, suggesting these patients may benefit from earlier intervention." — Alex Bondoc (clinical) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "Differential diagnosis for a one-year-old presenting with jaundice includes problems with the pancreatic or biliary tree, stone disease (choledocholithiasis, cholelithiasis), gallstone pancreatitis, and choledochal cyst." — Alex Bondoc (clinical) [Ep 1 · 5:12](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=312)
- "A one-year-old with jaundice is a little old for biliary atresia, which is usually considered in an infant." — Alex Bondoc (clinical) [Ep 1 · 5:12](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=312)
- "Physical exam findings to look for in suspected choledochal cyst include jaundice or scleral icterus and, in younger children, a palpable abdominal mass." — Alex Bondoc (clinical) [Ep 1 · 5:46](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- "Labs to check for suspected choledochal cyst include liver function tests (total, direct, and indirect bilirubin levels) and possibly a CBC to look for evidence of cholangitis or infection." — Alex Bondoc (clinical) [Ep 1 · 5:46](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- "The major initial screening imaging test for choledochal cyst is an abdominal ultrasound." — Alex Bondoc (clinical) [Ep 1 · 5:46](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- "Liver biopsy is not typically needed for older patients with reliable ultrasound imaging, but becomes critical in neonates or newborns to rule out cystic biliary atresia variant." — Alex Bondoc (clinical) [Ep 1 · 6:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=385)
- "CT scan is commonly used for choledochal cyst workup because of the ease with which young children can be scanned." — Alex Bondoc (clinical) [Ep 1 · 6:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- "MRCP is useful for choledochal cysts with hilar or intrahepatic disease to understand the extent of cystic change and to identify variant biliary anatomy, which occurs in 15 to 20% of patients." — Alex Bondoc (clinical) [Ep 1 · 6:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- "ERCP can be used for both diagnostic and therapeutic purposes in choledochal cysts, depending on prior scan findings and the type of cyst." — Alex Bondoc (clinical) [Ep 1 · 6:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- "There are no non-surgical treatment options for choledochal cysts." — Alex Bondoc (clinical) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- "Choledochal cysts require surgery due to the risk of recurrent cholangitis from biliary stasis and superinfection." — Alex Bondoc (clinical) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- "Type 1 and type 4 choledochal cysts with pancreaticobiliary malunion carry approximately an 8% lifetime risk of hepatobiliary malignancy, most specifically cholangiocarcinoma and gallbladder cancer." — Alex Bondoc (clinical) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- "Studies estimate the lifetime risk of malignancy in choledochal cysts to be anywhere from 6% to 30%." — Alex Bondoc (clinical) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- "Even after surgical resection of choledochal cysts, some studies suggest there is still about a 4% lifetime risk of malignancy, requiring lifelong surveillance." — Alex Bondoc (clinical) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- "If a patient with choledochal cyst presents with active infection, pancreatitis, or cholangitis, the best approach is to cool the patient off and treat the underlying process before scheduling surgery after sufficient recovery." — Alex Bondoc (clinical) [Ep 1 · 9:16](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=556)
- "For incidentally found choledochal cysts, surgery should be scheduled sooner rather than later, when it makes sense for the family schedule." — Alex Bondoc (opinion) [Ep 1 · 9:16](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=556)
- "Preoperative workup for choledochal cyst surgery includes laboratory values to ensure no other disease process is impairing liver function, and imaging (ultrasound and CT scan are often sufficient)." — Alex Bondoc (clinical) [Ep 1 · 10:14](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=614)
- "MRCP is recommended preoperatively if there is any question about the patient's anatomy or if the patient has a very proximal choledochal cyst or dilation into the hepatic ducts." — Alex Bondoc (clinical) [Ep 1 · 10:14](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=614)
- "The surgical goal for choledochal cyst repair is complete excision of the cyst." — Alex Bondoc (clinical) [Ep 1 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "For type 1 and type 4 choledochal cysts, the goal is to remove as much of the duct as possible, taking the duct all the way down behind or into the head of the pancreas to where it tapers, to avoid leaving remnant cyst." — Alex Bondoc (clinical) [Ep 1 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "For type 1 and type 4 choledochal cysts, biliary drainage reconstruction often includes a Roux-en-Y hepaticojejunostomy, but a hepaticoduodenostomy is also an option." — Alex Bondoc (clinical) [Ep 1 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "Type 2 choledochal cyst can be treated by simple removal of the diverticulum at its neck with repair of the common bile duct." — Alex Bondoc (clinical) [Ep 1 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "Type 3 choledochal cyst (limited choledochocele) can be treated with ERCP and sphincterotomy." — Alex Bondoc (clinical) [Ep 1 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "If type 3 choledochal cyst involves the wall of the duodenum, transduodenal resection options exist, and biopsy of the choledochocele mucosa is important because biliary epithelium exposed to intestinal secretions could become malignant." — Alex Bondoc (clinical) [Ep 1 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "Type 5 choledochal cyst (Caroli's disease) management depends on disease extent: if limited to an anatomic part of the liver, resection may be appropriate; if diffuse throughout the liver without adequate functional remnant, transplantation may be necessary." — Alex Bondoc (clinical) [Ep 1 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "For choledochal cyst surgery in children less than 2 years old, a transverse incision or right subcostal incision is preferred; for older children, an upper midline incision is a viable option." — Alex Bondoc (clinical) [Ep 1 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- "During choledochal cyst dissection, hepatic arteries are medial and the portal vein is posterior to the cyst." — Alex Bondoc (clinical) [Ep 1 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- "Dr. Bondock performs an intraoperative cholangiogram through the gallbladder to understand where the tapering of the distal cyst occurs to avoid leaving remnant cyst." — Alex Bondoc (clinical) [Ep 1 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- "For Roux-en-Y hepaticojejunostomy reconstruction, Dr. Bondock goes about 15 to 20 centimeters distal from the ligament of Treitz, performs a two-layer jejunojejunostomy, and does a hepaticojejunostomy with interrupted 5-0 or 6-0 Maxon suture." — Alex Bondoc (clinical) [Ep 1 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- "Dr. Bondock performs the Roux-en-Y limb retrocolic and closes the small bowel mesentery." — Alex Bondoc (clinical) [Ep 1 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- "For type 2 choledochal cyst, once the cyst is tapered down to the common bile duct, the neck is resected and the common bile duct is repaired with interrupted absorbable suture without leaving a T-tube." — Alex Bondoc (clinical) [Ep 1 · 16:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- "Type 3 choledochal cyst can be approached endoscopically with ERCP and sphincterotomy, but if the lesion is large and obstructing the common duct, a transduodenal approach is needed, sometimes with preoperative stents to separate it from the duodenum." — Alex Bondoc (clinical) [Ep 1 · 16:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- "Type 5 choledochal cyst (Caroli's disease) can be addressed surgically with liver resection if cystic disease is limited to one hemi-liver with adequate liver remnant and preserved biliary outflow, but if diffuse throughout the liver, liver transplantation may be necessary." — Alex Bondoc (clinical) [Ep 1 · 16:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- "Postoperative considerations for choledochal cyst surgery include enteric drainage and awaiting return of bowel function." — Alex Bondoc (clinical) [Ep 1 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Dr. Bondock typically places an NG tube postoperatively because of the new jejunojejunostomy, but tries to remove it the day after surgery." — Alex Bondoc (clinical) [Ep 1 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Drains are placed postoperatively to assess for biliary leaks from the new hepatoenteric anastomosis and are typically removed once the patient is tolerating a regular diet." — Alex Bondoc (clinical) [Ep 1 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Institutionally, patients are placed on a choleretic like Actigall and cholangitis prophylaxis (daily Bactrim) for three to six months after choledochal cyst surgery." — Alex Bondoc (clinical) [Ep 1 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Short-term to long-term surgical complications of choledochal cyst surgery include anastomotic stricture, small bowel obstruction from intra-abdominal surgery, reflux gastritis, and recurrent cholangitis." — Alex Bondoc (clinical) [Ep 1 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Lifelong follow-up is needed for choledochal cyst patients because of the possibility of developing future malignancy even after resection of the cyst." — Alex Bondoc (clinical) [Ep 1 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Choledochal cysts are a congenital dilation of the biliary tree." — Alex Bondoc (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=0)
- "In the Western world the incidence of choledochal cysts is about one in 100,000." — Alex Bondoc (epidemiological) [Ep 2 · 1:14](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=74)
- "In Asia, specifically Eastern Asia, choledochal cyst incidence is one in 13,000." — Alex Bondoc (epidemiological) [Ep 2 · 1:35](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=95)
- "Choledochal cysts have a female predominance." — Alex Bondoc (epidemiological) [Ep 2 · 1:14](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=74)
- "For Todani types 1 and 4, the etiology is likely embryologic relating to the pancreaticobiliary duct junction (pancreaticobiliary malunion)." — Alex Bondoc (clinical) [Ep 2 · 2:10](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=130)
- "Pancreaticobiliary malunion is just one theory for the etiology of choledochal cysts and doesn't explain the higher incidence in the Far East." — Alex Bondoc (opinion) [Ep 2 · 2:40](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=160)
- "In adults, the common channel (confluence of biliary and pancreatic ducts) is supposed to be less than 0.9 centimeters, but in pediatric patients any common channel is abnormal." — Alex Bondoc (clinical) [Ep 2 · 3:05](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=185)
- "Reflux of pancreatic enzymes into the biliary tree causes inflammation, degeneration, and epithelial changes." — Alex Bondoc (clinical) [Ep 2 · 3:30](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=210)
- "Type 5 choledochal cyst (Caroli's disease) has an associated genetic mutation in PKHD1." — Alex Bondoc (clinical) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=240)
- "Type 1 choledochal cyst is a dilation of the extrahepatic common bile duct only, either fusiform or saccular." — Alex Bondoc (clinical) [Ep 2 · 4:40](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=280)
- "Type 2 choledochal cyst is a small diverticulum off the common bile duct." — Alex Bondoc (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=300)
- "Type 3 choledochal cyst (choledochocele) is a dilation of the common bile duct in the wall of the duodenum." — Alex Bondoc (clinical) [Ep 2 · 5:10](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=310)
- "Type 4a choledochal cyst consists of multiple cysts in both the intra- and extrahepatic biliary tree." — Alex Bondoc (clinical) [Ep 2 · 5:25](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=325)
- "Type 4b choledochal cyst consists of multiple cysts in the extrahepatic biliary tree only." — Alex Bondoc (clinical) [Ep 2 · 5:40](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=340)
- "Type 5 choledochal cyst (Caroli's disease) has diffuse cystic dilation that can be throughout the liver or limited to one lobe." — Alex Bondoc (clinical) [Ep 2 · 5:50](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=350)
- "In younger children and infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound." — Alex Bondoc (clinical) [Ep 2 · 6:10](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=370)
- "In children, choledochal cysts often present with symptoms consistent with cholangitis such as jaundice or fever, and patients can have a palpable right upper quadrant mass." — Alex Bondoc (clinical) [Ep 2 · 6:25](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=385)
- "Giant choledochal cysts that children are born with can perforate and present with biliary ascites." — Alex Bondoc (clinical) [Ep 2 · 6:55](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=415)
- "Large choledochal cysts can be identified on 20-week fetal ultrasound and should be referred to a fetal center for workup and close monitoring after birth." — Alex Bondoc (guideline) [Ep 2 · 7:10](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=430)
- "A recent study showed that if a choledochal cyst was diagnosed prenatally and was larger than 4.5 centimeters at the 20-week anatomy scan, there was a higher rate of postnatal symptoms, suggesting these patients may benefit from earlier intervention." — Alex Bondoc (host_summary) [Ep 2 · 7:30](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=450)
- "In neonates or newborns with suspected choledochal cyst, liver biopsy is critical to rule out the cystic biliary atresia variant." — Alex Bondoc (guideline) [Ep 2 · 8:40](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=520)
- "While ultrasound and labs are sufficient to diagnose a choledochal cyst, axial imaging such as CT scan is needed before taking patients to the operating room." — Alex Bondoc (guideline) [Ep 2 · 9:00](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=540)
- "MRCP is useful for operative planning when there are questions about anatomic details, specifically for high disease (into the hilum or intrahepatic) to assess the extent of cystic change." — Alex Bondoc (clinical) [Ep 2 · 9:20](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=560)
- "Up to 15 to 20 percent of choledochal cyst patients have some kind of variant biliary tract anatomy." — Alex Bondoc (epidemiological) [Ep 2 · 7:31](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=451)
- "Surgery is the only true treatment option for choledochal cysts." (host_summary) [Ep 2 · 8:03](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=483)
- "The risk of developing cholangiocarcinoma in choledochal cyst patients can be as high as 26 percent according to some studies." (host_summary) [Ep 2 · 8:40](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=520)
- "Even after surgical resection of choledochal cysts, some studies suggest there is still about a 4 percent lifetime risk of malignancy, requiring lifelong surveillance." (host_summary) [Ep 2 · 9:00](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=540)
- "Patients presenting acutely with choledochal cysts can have pancreatitis or cholangitis, and infection/inflammation can make for a hostile surgical field." (host_summary) [Ep 2 · 9:25](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=565)
- "If a choledochal cyst is found incidentally, resection is not an emergency but it is better to schedule surgery sooner rather than later." (host_summary) [Ep 2 · 9:45](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=585)
- "For type 1 and type 4 choledochal cysts, the goal is to remove as much of the duct as possible, taking it behind or into the head of the pancreas down to where it tapers, to avoid leaving remnant cysts." (host_summary) [Ep 2 · 10:50](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=650)
- "Preoperative MRCP is usually sufficient to identify where the distal cyst tapers behind the pancreas, but intraoperative cholangiogram through the gallbladder is an option if imaging is unclear." (host_summary) [Ep 2 · 11:20](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=680)
- "Dr. Bondoc's preference for biliary reconstruction is a Roux-en-Y hepaticojejunostomy, though hepaticoduodenostomy is also an option." (host_summary) [Ep 2 · 11:50](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=710)
- "Dr. Bondoc constructs Roux-en-Y hepaticojejunostomies by going 15 to 20 centimeters distal from the ligament of Treitz, performing a jejunojejunostomy in two layers if child size allows, then doing a hepaticojejunostomy with interrupted 5-0 or 6-0 Maxon suture." — Alex Bondoc (clinical) [Ep 2 · 12:08](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=728)
- "Dr. Bondoc does not usually biopsy the liver unless there is something obvious, but does close the mesenteric defect." — Alex Bondoc (opinion) [Ep 2 · 13:20](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=800)
- "Type 2 choledochal cysts require resection of the diverticulum and primary repair of the common bile duct." — Alex Bondoc (clinical) [Ep 2 · 13:35](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=815)
- "For type 3 choledochal cysts, ERCP and sphincterotomy can be therapeutic in some cases." — Alex Bondoc (clinical) [Ep 2 · 13:50](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=830)
- "If a type 3 choledochal cyst is large and obstructing the common duct, a transduodenal approach is often needed to resect the cyst and reconstruct the outflow, sometimes with preoperative stents placed via ERCP." — Alex Bondoc (clinical) [Ep 2 · 14:05](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=845)
- "Type 5 choledochal cysts may require liver transplant if cystic disease is diffuse throughout the liver." — Alex Bondoc (clinical) [Ep 2 · 14:35](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=875)
- "If type 5 cystic burden is limited to one hemi-liver or allows for resection with adequate liver remnant and preserved biliary outflow, it can be addressed surgically with liver resection." — Alex Bondoc (clinical) [Ep 2 · 14:55](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=895)
- "Postoperatively, choledochal cyst patients have an NG tube for about 24 hours to protect the jejunal anastomosis and have temporary biliary drains until eating a regular diet to catch any leaks from the hepaticojejunostomy." — Alex Bondoc (clinical) [Ep 2 · 15:20](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=920)
- "Postoperative complications for choledochal cyst surgery include recurrent cholangitis due to the connection between the biliary tree and enteric system, anastomotic stricture, small bowel obstruction, and reflux gastritis." — Alex Bondoc (clinical) [Ep 2 · 15:50](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=950)
- "Prophylactically, choledochal cyst patients are put on Bactrim postoperatively; Actigall can also be helpful but may be institution-specific." — Alex Bondoc (clinical) [Ep 2 · 16:00](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=960)
- "Lifelong follow-up is critical for choledochal cyst patients because of the possibility of developing future malignancy even after resection of the cyst." — Alex Bondoc (guideline) [Ep 2 · 16:12](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=972)

## Changelog
- Sep 7: 3 items added automatically

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