What is a choledochal cyst?
This a congenital abnormality of the bile duct that causes abnormal enlargement of the bile duct. Different types of choledochal cysts can be found depending on the location and type of enlargement.
How do choledochal cysts present?
The majority of choledochal cysts present in childhood. The patient presents with jaundice due a decrease in drainage of bile from the abnormal bile duct. The poor drainage cause infections in the bile duct in many patient. Some patients develop repeated attacks of pancreatitis since the pancreatic duct may enter into the abnormal bile duct.
The diagnosis of choledochal cysts is not difficult once the condition is suspected. An ultrasound will show an abnormal bile duct and an ERCP will demonstrate the abnormal enlargement of the bile duct.
Treatment of choledochal cysts:
The treatment of choice for choledochal cysts is removal of the cyst by surgery. In this procedure the abnormal segment of the bile duct is completely removed by surgery and the small intestine is then brought up to the bile duct and sutured to the normal bile duct so that bile secretions are routed back into the intestine.
In the past the cyst with the abnormal diseased bile duct was often left in place and sutured to the small intestine to relieve the jaundice. Leaving the cyst behind and suturing the intestine to the cyst is no longer recommended since this procedure is associated with a number of serious complications. Up to 13% to 70% of patients in whom the cyst is not removed require re-operations to remove the cyst. Furthermore development of cancer in the cyst is a major concern.
Laparoscopic surgery for choledochal cyst
In selected patients with a favorable anatomy we will consider a laparoscopic approach for removal of the cyst. In this procedure the cyst is completely excised and a segment of small intestine is brought up and sutured to the normal bile duct so that bile secretion into the intestine is maintained.
Risk of bile duct cancerIf the cyst is not removed at the time of surgery then this exposes the patient to future development of bile duct cancer in the wall of the cyst. The incidence of cancer in a choledochal cyst is twenty times greater than that in the general population. 14% to 18% of the adult population with a choledochal cyst will develop cancer in a cyst if the cyst is not removed and, as the patient ages by the age of 50 up to 50% of patients will have cancer in the cyst.
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