Surgical management strategies and postoperative outcomes of choledochal cysts in children: the role of preoperative radiological assessment in a retrospective observational study.

BACKGROUND: Choledochal cysts (CCC) are common congenital biliary malformations in children. Early diagnosis and standardized surgery are critical for prognosis. Preoperative imaging is essential for classification and surgical planning, but the value of different modalities remains unclear.

PURPOSE: This study aimed to investigate the value of preoperative imaging in guiding surgical strategies for pediatric CCC, analyze its prognostic predictive efficiency, and explore related risk factors to provide evidence for individualized clinical management.

METHODS: A retrospective study enrolled 104 children with choledochal cysts surgically treated from January 2022 to December 2024. All diagnoses were confirmed by preoperative imaging, intraoperative exploration and postoperative pathology. Cysts were classified by the Todani system. Preoperative imaging included abdominal ultrasound (US), computed tomography (CT), magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) and intraoperative cholangiography (IOC). Key radiological features were collected. We analyzed the correlation between imaging features and surgical strategy. Primary outcomes were early postoperative complications and mid-term liver function abnormalities; secondary outcomes included operative time, blood loss, hospital stay and reoperation rate. Univariate and multivariate Logistic regression identified independent risk factors. A combined predictive model was constructed, and ROC curves evaluated its predictive performance (95% CI).

RESULTS: The most common types were Todani type I (65.4%) and type IVa (24.0%). Magnetic resonance cholangiopancreatography achieved a classification accuracy of 96.2% and exhibited higher detection rates of pancreaticobiliary maljunction and intrahepatic bile duct dilatation than ultrasound and computed tomography (P < 0.05). Cyst resection with Roux-en-Y hepaticojejunostomy was the predominant procedure (81.7%). The overall early postoperative complication rate was 16.3% and incomplete preoperative radiological assessment was an independent risk factor. The combined model of ultrasound and magnetic resonance cholangiopancreatography yielded an AUC of 0.872.

CONCLUSION: Preoperative imaging is essential for pediatric choledochal cyst management, and the combination of ultrasound and MRCP enables precise surgical planning and better prognosis.