Clinicopathological profile and surgical outcome of choledochal cysts: a prospective observational study from Bangladesh

Background: Choledochal cysts are uncommon congenital abnormalities of the biliary tract characterized by cystic dilatation of the extrahepatic and/or intrahepatic bile ducts. This study evaluated the clinicopathological characteristics, diagnostic profile, cyst morphology and surgical outcomes of patients with choledochal cysts treated at a tertiary surgical center in Bangladesh. Methods: This prospective observational study was conducted in the Department of Surgery, Bangladesh Medical University, Dhaka, from January 2013 to December 2014. Forty-two patients with choledochal cysts were included. Demographic characteristics, clinical presentation, associated hepatobiliary conditions, laboratory findings, imaging investigations, Todani classification, operative procedures, histopathological findings and postoperative complications were evaluated. Descriptive statistical analysis was performed. Results: Among 42 patients, 27 (64.3%) were female and 15 (35.7%) were male. Thirty-two patients (76.2%) were older than 20 years. Abdominal pain was the most frequent presenting symptom, occurring in 34 (81.0%) patients, followed by jaundice in 19 (45.2%). Todani type I was the predominant cyst type, identified in 20 (47.6%) patients, followed by type IV in 13 (31.0%). Type II, III and V cysts were present in 3 (7.1%), 1 (2.4%) and 5 (11.9%) patients, respectively. Ultrasonography was performed in all patients, while MRCP was performed in 38 (90.5%). Complete cyst excision was achieved in 34 (81.0%) patients, with Roux-en-Y hepaticojejunostomy being the predominant reconstructive procedure. Seven patients (16.7%) developed postoperative complications. One postoperative death occurred. Conclusions: Choledochal cysts in this series predominantly affected females and were frequently diagnosed during adulthood. Todani type I was the commonest anatomical subtype. Ultrasonography followed by MRCP provided the principal diagnostic pathway. Complete cyst excision with biliary reconstruction was the predominant definitive treatment. Early diagnosis and appropriate anatomical delineation may facilitate definitive surgery and reduce complications associated with delayed presentation.