Outcomes of Complete Excision and Roux-en-Y Hepaticojejunostomy for Choledochal Cysts: A Single-Center Experience
DOI:
https://doi.org/10.70749/ijbr.v3i7.2936Keywords:
Choledochal cyst, Biliary surgery, Hepaticojejunostomy, Roux-en-Y reconstruction, Pediatric hepatobiliary surgeryAbstract
Background: Choledochal cyst is a developmental abnormality of the biliary tract that is related to repeated cholangitis, pancreatitis, biliary cirrhosis, and malignancy. The treatment of full cyst removal and Roux-en-Y hepaticojejunostomy is assumed to be the most effective, but the outcome can differ in children and adults because of the variation in the evolution of the disease and inflammatory alterations. Objective: To evaluate surgical and functional outcomes of complete excision and Roux-en-Y hepaticojejunostomy for choledochal cysts in pediatric and adult patients at a single tertiary care center. Methodology: The study involved a descriptive observation, which was carried out in Organ Transplant Unit, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences/ Gambat Medical College, Gambat, District Khairpur Mir’s, between May 2024 and May 2025. A total of 55 patients of all age groups who were diagnosed with choledochal cyst underwent total cyst excision and then Roux-en-Y hepaticojejunostomy. Clinical findings before operation, radiological categorization, variables during operation, early postoperative complications, and late outcome were noted down. The comparison was performed through the proper statistical tests with p <0.05 as the significant value in pediatric and adult groups. Results: Among 55 patients, 29 (52.7%) were pediatric and 26 (47.3%) were adults, with female predominance (65.5%). Type I cyst was the most common subtype (76.4%). Adults presented more frequently with cholangitis and had higher bilirubin levels (p<0.05). Operative time and blood loss were significantly greater in adults. Early postoperative complications occurred in 29% of patients, most commonly surgical site infection and bile leak. Hospital stay was longer in adults (p=0.001). During follow-up, anastomotic stricture occurred in 9.1% and recurrent cholangitis in 12.7%, mainly in adults. Conclusion: Complete excision with Roux-en-Y hepaticojejunostomy is a safe and effective treatment for choledochal cysts. Early surgical intervention, particularly in pediatric patients, is associated with better outcomes and fewer long-term complications.
Downloads
References
1. Mahamud, M.T., et al., Evaluation of Outcome of Hepaticojejunostomy with or Without Roux-En-Y For the Treatment of Choledochal Cyst. 2022: p. 8-14.
https://doi.org/10.3329/jpsb.v13i1.87400
2. Ahmad, H., et al., Outcomes of hepaticojejunostomy for post-cholecystectomy bile duct injury. 2023. 51(3): p. 03000605231162444.
https://doi.org/10.1177/03000605231162444
3. Lu, H. and W.J.P.J.o.M.S. Hou, Comparison of open and laparoscopic outcomes of adult Type-I congenital choledochal cysts. 2023. 39(6): p. 1783.
https://doi.org/10.12669/pjms.39.6.7829
4. Hajibandeh, S., et al., Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy. 2022. 407(5): p. 1817-1829.
https://doi.org/10.1093/bjs/znac248.104
5. Pawar, J., et al., Comparison of perioperative surgical outcomes following total robotic and total laparoscopic Roux-en Y hepaticojejunostomy for choledochal cyst in paediatric population: a preliminary report from a tertiary referral centre. 2023. 39(1): p. 139.
https://doi.org/10.1007/s00383-023-05414-0
6. Asghar, M.S., et al., Experience of surgical management of rare cases of choledochal cyst in last five years—tertiary care reflection. 2023. 73(3): p. 677-80.
https://doi.org/10.47391/jpma.5245
7. Nasir, A.U.D., et al., Audit of management of adult choledochal cysts. 2021. 71: p. 1997-2000.
https://doi.org/10.51253/pafmj.v6i6.4476
8. Farooq, M.A., S.A. Khan, and M.I.J.P.j.o.m.s. Malik, Choledochal Cyst in Children, presentation and outcome-10 years’ experience from a tertiary care center in Pakistan. 2023. 39(2): p. 456.
https://doi.org/10.12669/pjms.39.2.6196
9. Schukfeh, N., et al., The role of laparoscopic treatment of choledochal malformation in Europe: A single-center experience and review of the literature. 2022. 32(06): p. 521-528.
https://doi.org/10.1055/s-0042-1749435
10. Jones, R.E., et al., A narrative review of the modern surgical management of pediatric choledochal cysts. 2021. 6: p. 37.
https://doi.org/10.21037/tgh-20-235
11. Jamal, A., et al., Pancreaticoduodenectomy: Outcomes of a complex surgical procedure from a developing country. 2020. 20(7): p. 1534-1539.
https://doi.org/10.1016/j.pan.2020.08.013
12. Ramsey, W.A., et al., Outcomes of laparoscopic versus open resection of pediatric choledochal cyst. 2023. 58(4): p. 633-638.
https://doi.org/10.1016/j.jpedsurg.2022.12.024
13. Pirzada, M.A., et al., Paraganglioma of common bile duct: A case report. 2022. 72(5): p. 983-985.
https://doi.org/10.47391/jpma.4286
14. Zhang, M.-x., et al., Comparison of efficacy and safety of robotic surgery and laparoscopic surgery for choledochal cyst in children: a systematic review and proportional meta-analysis. 2023. 37(1): p. 31-47.
https://doi.org/10.1007/s00464-022-09442-0
15. Bian, Z., et al., Curative effect and technical key points of laparoscopic surgery for choledochal cysts in children. 2023. 9: p. 1051142.
https://doi.org/10.21203/rs.3.rs-1932985/v1
16. Hando, D.J., et al., Choledochal cyst type I with dilated intrahepatic biliary radicles: a type IVA mimic. 2022. 12(1): p. 29.
https://doi.org/10.1186/s43066-022-00193-0
17. Bhutta, M.R., et al. Pediatric Choledochal Cyst, Symptoms/Signs, Management and Outcome, Our Experience. in Medical Forum Monthly. 2023.
18. Pradhan, A., B. Mallick, and S.J.A.o.t.R.S.f.C.B. Sekharpatra, Treatment of Choledochal Cyst in a Pediatric Population: A Case Series of Nine Patients from a Tertiary Care Teaching Medical Institution in Odisha, India. 2021. 25(4): p. 14391-14399.
19. Huang, J., et al., Cost-effectiveness analysis of robot-assisted laparoscopic surgery for complex pediatric surgical conditions. 2023. 37(11): p. 8404-8420.
https://doi.org/10.1007/s00464-023-10399-x
20. Zubair, N., K. Khandwala, and K. Hilal, Type-C pancreaticobiliary malformation with associated Type 1-C choledochal cyst..
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
