Diagnosis and Treatment of Choledochal Cysts: A Single-Center Experience

Abstract

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 treatme nt for Type I cysts. Materials and Methods: This retrospective study evaluates the clinical features, surgical approach, and short-to mid-term outcomes of Type I choledochal cysts in a single center. 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. However, the small sample size limits the generalizability of the findings. 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. The 12-month follow-up period was considered short-to mid-term. 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. © 2026, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.