Skip to main content
SpringerLink
Log in

Clinicopathological Feature and Surgical Outcome of Choledochal Cyst in Different Age Groups: The Implication of Surgical Timing

  • original paper
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background/aims

Surgical resection of choledochal cysts (CC) has become standard treatment. However, surgery is not universally recommended in early infancy and/or asymptomatic patients. In order to investigate the optimal timing of CC excision, we analyzed clinicopathological data and surgical results from different age groups.

Material and methods

This retrospective review included 107 patients (77 females, 30 males) who underwent CC resection at the National Taiwan University Hospital between January 1988 and December 2005. Patient demographic, clinical, and surgical data were collected and analyzed.

Results

The patients were divided into three groups according to age at the time of surgery: <1 year old (group I, n = 26), 1−16 years old (group II, n = 48), and >16 years old (group III, n = 33). About two thirds of the patients in group I had jaundice, while abdominal pain related to inflammation was the commonest symptom in groups II and III. Group I suffered significantly fewer surgical complications and less severe liver fibrosis than groups II or III.

Conclusion

CC surgery in infancy and in asymptomatic patients is safe and may prevent the complications of this condition. The results support a recommendation for early excision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Juttijudata P, Chiemchaisri C, Palavatana C, Churnratanakul S. Causes of cholestasis in Thailand. A study of 276 consecutive patients. Am J Surg 1984;147:360–366. doi:10.1016/0002-9610(84)90167-3.

    Article  PubMed  CAS  Google Scholar 

  2. Nicholl M, Pitt HA, Wolf P, Cooney J, Kalayoglu M, Shilyansky J, Rikkers LF. Choledochal cysts in western adults: complexities compared to children. J Gastrointest Surg 2004;8:245–252. doi:10.1016/j.gassur.2003.12.013.

    Article  PubMed  Google Scholar 

  3. Chen HM, Jan YY, Chen MF, Wang CS, Jeng LB, Hwang TL, Chen SC, Chao TC. Surgical treatment of choledochal cyst in adults: results and long-term follow-up. Hepatogastroenterology 1996;43:1492–1499.

    PubMed  CAS  Google Scholar 

  4. Chaudhary A, Dhar P, Sachdev A, Kumar N, Vij JC, Sarin SK, Broor SL, Sharma SS. Choledochal cysts—differences in children and adults. Br J Surg 1996;83:186–188. doi:10.1002/bjs.1800830212.

    Article  PubMed  CAS  Google Scholar 

  5. Metcalfe MS, Wemyss-Holden SA, Maddern GJ. Management dilemmas with choledochal cysts. Arch Surg 2003;138:333–339. doi:10.1001/archsurg.138.3.333.

    Article  PubMed  Google Scholar 

  6. Alonso-Lej F, Rever WB Jr, Pessagno DJ. Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases. Int Abstr Surg 1959;108:1–30.

    PubMed  CAS  Google Scholar 

  7. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 1977;134:263–269. doi:10.1016/0002-9610(77)90359-2.

    Article  PubMed  CAS  Google Scholar 

  8. Suita S, Shono K, Kinugasa Y, Kubota M, Matsuo S. Influence of age on the presentation and outcome of choledochal cyst. J Pediatr Surg 1999;34:1765–1768. doi:10.1016/S0022-3468(99)90308-1.

    Article  PubMed  CAS  Google Scholar 

  9. Lee SC, Kim HY, Jung SE, Park KW, Kim WK. Is excision of a choledochal cyst in the neonatal period necessary? J Pediatr Surg 2006;41:1984–1986. doi:10.1016/j.jpedsurg.2006.08.023.

    Article  PubMed  Google Scholar 

  10. Song HK, Kim MH, Myung SJ, Lee SK, Kim HJ, Yoo KS, Seo DW, Lee HJ, Lim BC, Min YI. Choledochal cyst associated the with anomalous union of pancreaticobiliary duct (AUPBD) has a more grave clinical course than choledochal cyst alone. Korean J Intern Med 1999;14:1–8. doi:10.1007/BF02706034.

    PubMed  CAS  Google Scholar 

  11. Jan YY, Chen HM, Chen MF. Malignancy in choledochal cysts. Hepatogastroenterology 2002;49:100–103.

    PubMed  Google Scholar 

  12. Liu CL, Fan ST, Lo CM, Lam CM, Poon RT, Wong J. Choledochal cysts in adults. Arch Surg 2002;137:465–468. doi:10.1001/archsurg.137.4.465.

    Article  PubMed  Google Scholar 

  13. Stain SC, Guthrie CR, Yellin AE, Donovan AJ. Choledochal cyst in the adult. Ann Surg 1995;222:128–133. doi:10.1097/00000658-199508000-00004.

    Article  PubMed  CAS  Google Scholar 

  14. Ohtsuka T, Inoue K, Ohuchida J, Nabae T, Takahata S, Niiyama H, Yokohata K, Ogawa Y, Yamaguchi K, Chijiiwa K, Tanaka M. Carcinoma arising in choledochocele. Endoscopy 2001;33:614–619. doi:10.1055/s-2001-15324.

    Article  PubMed  CAS  Google Scholar 

  15. Tsuchiya R, Harada N, Ito T, Furukawa M, Yoshihiro I. Malignant tumors in choledochal cysts. Ann Surg 1977;186:22–28. doi:10.1097/00000658-197707000-00004.

    Article  PubMed  CAS  Google Scholar 

  16. Lai HS, Duh YC, Chen WJ, Chen CC, Hung WT, Lee PH, Huang SF. Manifestations and surgical treatment of choledochal cyst in different age group patients. J Formos Med Assoc 1997;96:242–246.

    PubMed  CAS  Google Scholar 

  17. Cheng MT, Chang MH, Hsu HY, Ni YH, Lai HS, Chen CC, Chen WJ, Hsieh FJ, Chu JS. Choledochal cyst in infancy: a follow-up study. Acta Paediatr Taiwan 2000;41:13–17.

    PubMed  CAS  Google Scholar 

  18. Yeong ML, Nicholson GI, Lee SP. Regression of biliary cirrhosis following choledochal cyst drainage. Gastroenterology 1982;82:332–335.

    PubMed  CAS  Google Scholar 

  19. Yamaguchi M. Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature. Am J Surg 1980;140:653–657. doi:10.1016/0002-9610(80)90051-3.

    Article  PubMed  CAS  Google Scholar 

  20. Houben CH, Chiu PW, Lau J, Lee KH, Ng EK, Tam YH, Yeung CK. Preoperative endoscopic retrograde cholangiopancreatographic treatment of complicated choledochal cysts in children: a retrospective case series. Endoscopy 2007;39:836–839. doi:10.1055/s-2007-966654.

    Article  PubMed  CAS  Google Scholar 

  21. Ando K, Miyano T, Kohno S, Takamizawa S, Lane G. Spontaneous perforation of choledochal cyst: a study of 13 cases. Eur J Pediatr Surg 1998;8:23–25.

    Article  PubMed  CAS  Google Scholar 

  22. Komi N, Tamura T, Miyoshi Y, Kunitomo K, Udaka H, Takehara H. Nationwide survey of cases of choledochal cyst. Analysis of coexistent anomalies, complications and surgical treatment in 645 cases. Surg Gastroenterol 1984;3:69–73.

    PubMed  CAS  Google Scholar 

  23. Todani T, Watanabe Y, Toki A, Urushihara N. Carcinoma related to choledochal cysts with internal drainage operations. Surg Gynecol Obstet 1987;164:61–64.

    PubMed  CAS  Google Scholar 

  24. Ishibashi T, Kasahara K, Yasuda Y, Nagai H, Makino S, Kanazawa K. Malignant change in the biliary tract after excision of choledochal cyst. Br J Surg 1997;84:1687–1691. doi:10.1002/bjs.1800841212.

    Article  PubMed  CAS  Google Scholar 

  25. Lenriot JP, Gigot JF, Segol P, Fagniez PL, Fingerhut A, Adloff M. Bile duct cysts in adults: a multi-institutional retrospective study. French Associations for Surgical Research. Ann Surg 1998;228:159–166. doi:10.1097/00000658-199808000-00003.

    Article  PubMed  CAS  Google Scholar 

  26. Hewitt PM, Krige JE, Bornman PC, Terblanche J. Choledochal cysts in adults. Br J Surg 1995;82:382–385. doi:10.1002/bjs.1800820333.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

This work was supported by the institutional grants from National Taiwan University Hospital 97-N-1006 and National Taiwan University Hospital Yun-Lin Branch 96-N-017.

Author information

Authors and Affiliations

  1. Department of Surgery, National Taiwan University Hospital, No 7, Chung-Shan South Rd, Taipei, Taiwan

    Ming-Shian Tsai, Wen-Hsi Lin, Wen-Ming Hsu, Hong-Shiee Lai, Po-Huang Lee & Wei-Jao Chen

  2. National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Ming-Shian Tsai

Authors
  1. Ming-Shian Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wen-Hsi Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wen-Ming Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hong-Shiee Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Po-Huang Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wei-Jao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hong-Shiee Lai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tsai, MS., Lin, WH., Hsu, WM. et al. Clinicopathological Feature and Surgical Outcome of Choledochal Cyst in Different Age Groups: The Implication of Surgical Timing. J Gastrointest Surg 12, 2191–2195 (2008). https://doi.org/10.1007/s11605-008-0593-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0593-9

Keywords

Search

Navigation