Diagnosis and Treatment of Choledochal Cysts: A Single-Center Experience
Serhat Binici1, Fırat Aslan1, Iklil Eryılmaz2, Veysel Tahiroğlu3, Muhammed Berkcan Bingöl1, Ahmet Burak Cicek1, Burhan Beger4, Kemal Ayengin41Van Yüzüncü Yıl University Faculty of Medicine Department of General Surgery2Şırnak State Hospital General Surgery Clinic
3Şirnak University Faculty of Health Sciences Department of Nursing, Şirnak, Türkiye
4Van Yüzüncü Yıl Univercity Pediatric Surgery Departmant
INTRODUCTION: Choledochal cysts are rare congenital biliary malformations with a lifelong malignancy risk. Although prenatal ultrasonography and MRCP have improved early diagnosis, total cyst resection with biliary reconstruction remains the definitive treatment for Type I cysts. This study evaluates the clinical features, surgical approach, and short- to mid-term outcomes of Type I choledochal cysts in a single center.
METHODS: Nine patients operated between 2015 and 2025 were retrospectively reviewed. All had Todani Type I cysts and underwent open total cyst resection with Roux-en-Y hepaticojejunostomy. Data on demographics, clinical presentation, imaging, postoperative complications, liver function, and follow-up were analyzed. Follow-up included clinical assessment and ultrasonography at 1, 3, and 12 months.
RESULTS: Median age was 12 years (IQR 8–15); 55.6% were female. Diagnosis was made by ultrasonography alone in 66.7% of cases, with MRCP added in 33.3%. Median hospital stay was 6 days, with no sex-based difference. Postoperative morbidity was 11.1%; one patient developed a low-output hepaticojejunostomy leak, resolving conservatively by the third month. No other significant complications occurred. Patients with elevated preoperative liver function tests showed marked postoperative improvement. At 12 months, no strictures, recurrence, or late complications were detected, and clinical status remained stable.
DISCUSSION AND CONCLUSION: Open total cyst resection with Roux-en-Y hepaticojejunostomy is safe and effective for Type I choledochal cysts, providing low morbidity, biochemical improvement, and recurrence-free short- to mid-term outcomes. MRCP complements ultrasonography in anatomical assessment. Given the persistent malignancy risk, risk-stratified long-term follow-up is essential. Larger multicenter prospective studies are needed to optimize surgical timing, approach, and long-term outcomes.
Keywords: Choledochal cyst, hepaticojejunostomy, MRCP, pediatric surgery, malignancy risk
Manuscript Language: English