The surgical treatment of choledochal cyst.

Eleven consecutive infants and children with choledochal cyst were evaluated for operative resection of the cyst as the primary surgical therapy. Total excision and biliary reconstruction by choledochojejunostomy was successfully performed in nine patients. Simple intestinal drainage of the cyst was used in two instances because of severe liver disease. Four patients had coexisting biliary malformations. In all five infants, biopsy of the liver was consistent with biliary atresia. In addition, the extrahepatic bile ducts proximal to the cyst were obliterated in two infants. The findings suggest that pathogenesis of choledochal cyst may be different in infants than in older children. The indications for excision of the cyst in four patients were due to complications from earlier internal drainage procedures. In most patients, including all those having had a cystoenterostomy earlier, resection was done from the inside of the cyst, thus minimizing the danger of injury to the neighboring vascular structures. There were no operative deaths, and morbidity was minor. The traditional operation for a choledochal cyst has been internal drainage of the cyst into the intestine. Because of the high incidence of late complications and the frequent association of major co-existing biliary malformations, the procedure should be reserved for highly specific indications. Total surgical excision is the procedure of choice for a choledochal cyst.