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Choledochal Cyst
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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While ultrasound and labs are sufficient to diagnose a choledochal cyst, axial imaging such as CT scan is needed before taking patients to the operating room. — Alex Bondoc, Choledochal Cysts: In Brief with Dr. Alexander Bondoc · 9:00
Choledochal Cysts: In Brief with Dr. Alexander Bondoc
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Are you having difficulty keeping the 5 types of choledochal cyst straight? Each has unique anatomy and management principles. Join Dr. Alexander Bondoc in an overview of Choledochal Cysts for the surgical trainee.
podcast16:55 · May 2022
Outcomes of laparoscopic versus open resection of pediatric choledochal cyst
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"Outcomes of laparoscopic versus open resection of pediatric choledochal cyst"
Ramsey et al, Journal of Pediatric Surgery
https://www.jpedsurg.org/article/S0022-3468(22)00799-0/fulltext
Video: Ellen Encisco
video0:54 · May 2023
Prenatally diagnosed choledochal cysts require fetal consultation at a fetal surgery center for establishment of care and counseling, because cystic biliary atresia must be ruled out postnatally. — Alex Bondoc, Choledochal Cyst Podcast · 3:25
Choledochal Cyst Podcast
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In this podcast, Dr. Alex Bondoc and Dr. Rae Hanke discuss the intricacies of choledochal cysts. Contributing editor: Dr. Rod Gerardo.Choledochal Cyst- Definition: Congenital cystic dilation of the biliary tree- Epidemiology: We
podcast22:07 · Dec 2020
Expert statements from the recordings in this collection.
Outcomes of laparoscopic versus open resection of pediatric choledochal cyst
The study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018.
The majority of patients underwent open resection.
Patients who underwent open resection were more likely to have a Roux-en-Y hepaticojejunostomy.
Patients who underwent laparoscopic resection were more likely to have a hepaticoduodenostomy.
Patients who underwent open resection were more likely to have a longer length of hospital stay.
Patients who underwent open resection were more likely to have more complications.
Patients who underwent open resection had higher total costs.
Choledochal Cyst Podcast
Choledochal cyst is a congenital cystic dilation of the biliary tree.
Alex Bondoc0:29
Incidence of choledochal cysts in the Western world is about 1 in 100,000.
Alex Bondoc0:36
In Eastern Asia, choledochal cyst incidence is 1 in 13,000.
Alex Bondoc0:36
Choledochal cysts are three to four times more likely in females than in males.
Alex Bondoc0:36
There is no genetic predisposition to choledochal cysts, but some genes including PKD1 have been identified in limited studies for type 5 choledochal cysts.
Alex Bondoc0:36
The most common classification system for choledochal cysts was developed by a surgeon named Tadani in Japan and includes five types.
Alex Bondoc1:10
For types 1 and 4 choledochal cysts, the etiology is likely embryologic, relating to pancreaticobiliary duct junction (pancreaticobiliary malunion), which creates a long common channel of the pancreaticobiliary duct.
Alex Bondoc1:10
Reflux of pancreatic enzymes from the head of the pancreas back into the biliary tree causes inflammation, degeneration, and epithelial changes in types 1 and 4 choledochal cysts.
Alex Bondoc1:10
In type 5 choledochal cysts, genetic mutation might predispose to more diffuse dilation of both the intra- and extrahepatic biliary trees.
Alex Bondoc1:10
Type 1 choledochal cyst is a dilation of the extrahepatic common bile duct only, which can be fusiform or saccular.
Alex Bondoc2:05
Type 2 choledochal cyst is a small diverticulum off of the common bile duct.
Alex Bondoc2:05
Type 3 choledochal cyst is a choledochocele affecting the portion of the common bile duct in the wall of the duodenum.
Alex Bondoc2:05
Type 4a choledochal cyst consists of multiple cysts in both the intra- and extrahepatic biliary tree.
Alex Bondoc2:05
Type 4b choledochal cyst consists of multiple cysts in the extrahepatic biliary tree only.
Alex Bondoc2:05
Type 5 choledochal cyst is intrahepatic only and diffusely throughout, called Caroli's disease, which can be diffuse or limited to one lobe or one hemi-liver.
Alex Bondoc2:05
In younger children such as infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound for other causes.
Alex Bondoc3:25
In children, choledochal cysts often present with symptoms consistent with cholangitis, such as jaundice or fever.
Alex Bondoc3:25
Patients with choledochal cysts can have a palpable right upper quadrant mass.
Alex Bondoc3:25
The triad of jaundice, fever, and palpable right upper quadrant mass (Charcot's triad) is incredibly uncommon as a presentation of choledochal cysts.
Alex Bondoc3:25
Giant choledochal cysts in small children can perforate and present with biliary ascites.
Alex Bondoc3:25
Giant choledochal cysts can be diagnosed prenatally on week 20 ultrasounds.
Alex Bondoc3:25
Prenatally diagnosed choledochal cysts require fetal consultation at a fetal surgery center for establishment of care and counseling, because cystic biliary atresia must be ruled out postnatally.
A recent citation demonstrated that if a choledochal cyst was diagnosed prenatally and was larger than 4.5 centimeters at the 20-week anatomy scan, there was a higher rate of postnatal symptomatology, suggesting these patients may benefit from earlier intervention.
Alex Bondoc3:25