Management of Choledochal Cyst at Tertiary Centre: A Review of Literature and Personal Experience

Abstract

Rakesh R*, Rambhupal Choudary, Prashant Kanni Y, Praveen Mathew, Sidhartha Naidu B and Reshma Rajeev

Background: Choledochal cysts are dilations of the bile ducts, occurring in both children and adults. In adults, the clinical course differs due to associated hepatobiliary disease. Cysto-enterostomy was the primary treatment but had limitations, so complete cyst excision is preferred when possible to avoid recurrence and malignant change.

Method: A 5-year retrospective analysis was conducted on 33 patients diagnosed with choledochal cysts and treated at the Department of General Surgery and Surgical Gastroenterology between January 2015 and February 2020.

Results: The study involved 33 patients with choledochal cysts, predominantly females (63%), with an average age of 28 years. Abdominal pain and vomiting were the most common symptoms. The Todani classification system was used to categorize the cysts, with the majority being type I (51.5%) and IV A (36.3%). 18% of cases had Abnormal Pancreatico Biliary Junction (APBJ) abnormality and only one patient had raised pre-operative CA-19.9 levels (Cyst Excision). Majority of patients (31) underwent complete cyst excision and HJ (Hepatico Jejunostomy), with only one anastomotic leak and one patient developing pleural effusion and pulmonary embolism. All specimens were suggestive of choledochal cysts with no malignant features. One patient developed anastomotic stricture with hepatolithiasis on follow-up and underwent re-do HJ.

Conclusion: Management of choledochal cyst involves detailed evaluation preoperatively with Magnetic Resonance Cholangio Pancreatography (MRCP) to categorise the type of cyst and to plan the surgery which involves complete excision of cyst with reconstruction by hepatico-jejunostomy. Complete excision of cyst gives a good outcome with minimal morbidity. Long term follow up is essential to detect and manage complications and malignant change.