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Tactics, techniques, and challenges in the management of giant choledochal cyst in adolescents and adults: a retrospective cohort study

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Abstract

Background

Choledochal cyst is a rare congenital anomaly manifesting as cystic dilatation of the biliary tree. This study presents our 5-year experience with giant choledochal cyst in adolescents and adults, focusing primarily on its clinical presentation, operative challenges, and pragmatic solutions.

Methods

A retrospective observational study was conducted on 58 adolescent and adult choledochal cyst patients who were managed at a tertiary care hospital. Giant choledochal cyst is defined as cyst with a maximum diameter of ≥ 10 cm. Demographic profile, clinical presentation, and surgical outcome of these patients were analyzed.

Results

A total of 12 patients with giant choledochal cyst were managed in our department in a duration of 5 years. The median age of patients with giant choledochal cyst was 20 years (range, 13–30 years) and male to female ratio was 1:2. Giant choledochal cysts were more symptomatic and 8 out of 12 presented with classic triad of abdominal pain, mass, and jaundice. One patient with giant choledochal cyst had metastatic cholangiocarcinoma. Eleven patients underwent surgical cyst excision. Surgery of the giant cyst was challenging and required technical modifications for safe excision.

Conclusion

Giant choledochal cyst is an unusual entity that is rarely encountered beyond first decade of life. These cysts pose unique surgical challenges and require modification of the standard operative technique.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

    Saket Kumar, Saurabh Singla, Sanjay Kumar, Rakesh Kumar Singh, Amarjit Kumar Raj & Manish Mandal

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  1. Saket Kumar
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  2. Saurabh Singla
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  3. Sanjay Kumar
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Contributions

Saket K, SS, Sanjay K, and MM: conception or design of the work; Saket K, Sanjay K, RKS, and AKR: the acquisition, analysis, or interpretation of data for the work; Saket K, SS, Sanjay K, AKR, RKS, and MM: drafting the work or revising it critically for important intellectual content; Saket K, SS, Sanjay K, AKR, RKS, and MM have approved the final version to be published; Saket K, SS, Sanjay K, AKR, RKS, and MM: agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Saket Kumar.

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Kumar, S., Singla, S., Kumar, S. et al. Tactics, techniques, and challenges in the management of giant choledochal cyst in adolescents and adults: a retrospective cohort study. Langenbecks Arch Surg 406, 1925–1933 (2021). https://doi.org/10.1007/s00423-021-02209-6

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  • DOI: https://doi.org/10.1007/s00423-021-02209-6

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