Timing of surgery for symptomatic choledochal cysts with hyperamylasemia in children: a retrospective analysis.

PURPOSE: This study aims to investigate the optimal surgical timing for symptomatic choledochal cyst (CDC) with hyperamylasemia in children.

METHODS

We retrospectively reviewed 61 symptomatic CDC patients with hyperamylasemia who underwent cyst excision and Roux-en-Y hepaticojejunostomy between July 2020 and November 2021. Patients were either in symptomatic phase or in remission at the time of surgery.

RESULTS

Thirty-seven patients were assigned to the symptomatic group and 24 to the remission group, with no significant difference in conversion rates (5.4% vs. 4.2%, P = 1.000). In the symptomatic group, two patients (5.4%) developed biliary fistulas, and two (5.4%) experienced pancreatitis. In the remission group, one patient (4.2%) had active bleeding, and one (4.2%) developed a biliary fistula without statistically significant difference (P = 1.000). The median total, preoperative, and postoperative hospital stays were comparable between the groups (P = 0.411, P = 0.159, and P = 0.731, respectively). However, costs were higher in the symptomatic group (P = 0.043). The two groups exhibited similar pathological inflammation severity (P = 0.065).

CONCLUSION

Postponing surgery until symptom remission demonstrates no therapeutic advantage for children with CDC and hyperamylasemia. Early surgery should be considered, provided that the general condition of the patient permits.