Choledochal Cyst Diagnosis and Surgical Management

Choledochal cysts are congenital dilatations of the biliary tract that present a spectrum of anomalies ranging from isolated extrahepatic cysts to complex intrahepatic involvement. They are classified according to the Todani system, with type I (fusiform extrahepatic dilatation) the most common. Clinical presentation varies by age: in infancy jaundice, abdominal pain and palpable mass are typical, whereas older children and adults may present with recurrent cholangitis, pancreatitis or biliary colic. Imaging underpins diagnosis, with ultrasonography as the first-line modality and magnetic resonance cholangiopancreatography (MRCP) providing non-invasive, high-resolution delineation of ductal anatomy. Computed tomography and intraoperative cholangiography supplement assessment, particularly where pancreaticobiliary maljunction or intrahepatic cysts are suspected. The standard of care is complete excision of the extrahepatic bile duct with reconstruction via a Roux-en-Y hepaticojejunostomy, thereby reducing the lifelong risk of cholangiocarcinoma. Open surgery remains widely practised, but minimally invasive approaches—laparoscopic and robotic—have demonstrated shorter hospital stay, reduced blood loss and improved postoperative recovery once surgical teams overcome the initial learning curve. Long-term surveillance is essential to detect late complications, including anastomotic stricture, biliary stones and malignancy arising in remnant ducts.

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Choledochal Cyst Diagnosis and Surgical Management publication trend

The graph below shows the total number of articles in choledochal cyst diagnosis and surgical management across all publications each year (not limited to Nature Index journals).

Technical terms

Choledochal cyst: Congenital dilatation of the bile ducts.

Roux-en-Y hepaticojejunostomy: Reconstruction connecting the hepatic duct to the jejunum in a Y-shaped configuration.

Magnetic Resonance Cholangiopancreatography (MRCP): MRI technique for non-invasive visualisation of biliary and pancreatic ducts.

Radiomics: Quantitative extraction of imaging features to support diagnostic and prognostic modelling.

Pancreaticobiliary maljunction: Anatomical anomaly in which pancreatic and bile ducts merge outside the duodenal wall, predisposing to reflux and inflammation.

References

1. Development of a simplified model and nomogram in preoperative diagnosis of pediatric chronic cholangitis with pancreaticobiliary maljunction using clinical variables and MRI radiomics. Insights into Imaging (2023).
2. Risk of subsequent biliary malignancy in patients undergoing cyst excision for congenital choledochal cysts. Journal of Gastroenterology and Hepatology (2013).
3. Evaluation of the learning curve of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: CUSUM analysis of a single surgeon’s experience. Surgical Endoscopy (2016).
4. Comparison of efficacy and safety of laparoscopic excision and open operation in children with choledochal cysts: A systematic review and update meta-analysis. PLOS ONE (2020).
5. Trans-umbilical Single-Site Plus One Robotic Assisted Surgery for Choledochal Cyst in Children, a Comparing to Laparoscope-Assisted Procedure. Frontiers in Pediatrics (2022).