Surgical treatment of choledochal cysts in children

Choledochal cyst is often associated with pancreatobiliary malunion, and pancreatic juice usually refluxes into the bile duct via the malunion. Various pathological conditions develop in the biliary tract, pancreas, and liver: cholangitis, biliary dilatation, biliary perforation, biliary cancer, acute pancreatitis, and/or biliary cirrhosis. The performance of cystenterostomy has recently been abandoned because of high morbidity after surgery. Accurate delineation of the biliary tree and the pancreatobiliary junction obtained by endoscopic retrograde cholangiopancreatography or operative cholangiography is necessary. Cyst excision should be performed to prevent ascending cholangitis and biliary cancer. Many types of procedures are employed in biliary reconstruction, but free drainage of bile is imperative for preventing cholangitis and stone formation. This can be achieved only by a wide anastomosis performed at the hilum after ductoplasty.