Choledochal Cyst Treatment Options
The treatment for a choledochal cyst is surgery. The purpose is to remove the cyst and create good bile flow from the liver to the small intestine.
Type I cysts. For children with type I cysts (their common bile duct balloons out), the surgery is called Roux-en-Y hepaticojejunostomy. “Hepatic” has to do with the liver. “Jejunum” is the middle segment of the small intestine.
At the time of surgery, we give your child medicine to make them sleep without pain (general anesthesia).
Your child’s surgeon cuts the common bile duct on each side of the cyst and takes out the cyst.
Next the surgeon cuts through the small intestine. The surgeon brings the lower part of the intestine up and sews it to the bile duct. This makes a new complete tube. Bile can now flow from your child’s liver into their intestine.
Then the surgeon cuts a hole in the side of the new tube. The surgeon brings the upper part of the intestine down and sews it to this hole. Now food can move from your child’s stomach into their intestine.
Other types of cysts. For children with other types of cysts, the surgery may be different. Your child’s surgeon will explain the type of surgery that’s best for your child and will describe the steps to you. In most cases, the purpose of surgery is the same – to take out any cyst that is outside the liver. (Surgery is different for type III cysts, or choledochocele.) If cysts are inside the liver and causing liver problems, your child might need one part (lobe) of their liver removed. This is not common.
Laparoscopic surgery. Some children can have their surgery through small cuts (“keyhole” incisions) in their belly (laparoscopic surgery, or minimally invasive procedure). The surgeon may do this directly or in some cases may do it using the da Vinci robot. For some children, surgeons need to make one longer incision, called an open approach, in order to reach the cyst and intestine. Your child’s surgeon will explain the method that is best for your child.
If your child has infected bile ducts (cholangitis), the doctor will give your child antibiotics to fight the infection. This may need to be done in the hospital.
After surgery, your child will be in the recovery room for about an hour. Then they will go to a regular hospital room and eventually to home. Usually, children with choledochal cyst stay in the hospital seven days. This depends on factors like when your child gets back to eating normally and when their pain is well controlled with medicines taken by mouth. Often children need a drain left in the side of their belly after surgery. In most cases, we will remove this before your child goes home.
Your child will have a follow-up visit with the surgeon two to three weeks after the surgery to make sure their incision is healing well.
After healing from surgery, your child will need to visit the doctor from time to time for regular check-ups and if they have any symptoms. It’s important to make sure their bile keeps flowing well.