The management of choledochal cysts in the newborn

Abstract

Choledochal cysts are now being diagnosed before birth on routine maternal sonography (US). There is no report in the literature outlining the management of newborns with choledochal cysts, many of whom are asymptomatic. Our study details the diagnosis, treatment and outcome of six such children, four girls and two boys. Five had antenatal US revealing cystic abdominal masses. One had intermittent vomiting and US suggested a choledochal cyst. Four of six had normal serum bilirubin levels; two had elevations. In five babies the choledochal cyst was correctly diagnosed from the preoperative studies; in one the preoperative diagnosis was an ovarian cyst. The children underwent an operation at an average of 6 weeks of age (range 5 days to 17 weeks). At exploration, cholangiography showed Alonso-Lej type I cysts in all cases. Treatment consisted of resection of the cyst with Roux-en-Y choledochojejunostomy in five and with a valved jejunal choledochoduodenal conduit in one. In no case was the dissection of the choledochal cyst off the portal vein and hepatic artery difficult. There were no intra- or early postoperative complications. Mean hospital stay was 8 days (range 5 to 9 days). Presently, all 6 patients have normal bilirubin levels at an average length of follow-up of 35 months (range 16 to 70 months) after operation. We conclude that operative treatment of choledochal cysts in early infancy, even in asymptomatic children, is safe and effective and may prevent serious complications later in life.

Timing of surgery for prenatally diagnosed asymptomatic choledochal cysts: a prospective randomized study

“…With the development of surgical technique, neonatal cyst excision and Roux-en-Y hepatojejunostomy became feasible and safe. Burnweit et al [6] reported that surgical intervention for CDC in early infancy, even in asymptomatic patients, was safe and effective. O'Neill and associates [5] successfully performed surgery for CDC patient within 2 weeks of life.…”

“…The appropriate timing of surgery for asymptomatic newborn CDC is not clearly defined. Development of surgical techniques and application of laparoscopic surgery improved the outcome of operations in the neonatal period and early infancy [5][6][7]. We herewith designed a prospectively randomized trial to assess the optimal timing of surgery for prenatally diagnosed asymptomatic CDC.…”

Diagnosis and management of biliary cystic malformations in neonates

“…Neonatal surgery on a thin-walled CC can be technically difficult and may lead to further anastomotic complications, such as anastomotic leakage or stricture [5]. On the other hand, Burnweit et al [6] reported that operative treatment of CCs in early infancy is safe and effective and may prevent serious complications later in life. We performed surgery within 60 days of birth in BA patients and 1 to 6 months of age in CC patients without complications.…”

“…Recent advances in ultrasonography have made it possible to identify biliary atresia (BA) and choledochal cyst (CC) prenatally and neonatally [1][2][3][4][5][6][7]. Although CC is most commonly a congenital dilatation of the bile duct [8], some cases of prenatally diagnosed BA were reported to have biliary cystic malformations (BCM) under the hepatic hilum [1][2][3]7].…”

Impact of prenatal diagnosis on choledochal cysts and the benefits of early excision

“…This is in part because of the fact that most of these patients are asymptomatic and also because of the increased technical difficulty in fashioning the hepaticojejunostomy during the neonatal period, which may result in potential post‐operative complications. As a result, the optimal timing of surgery in these neonates remains controversial 14–16 …”