Retrospective Cohort Study of Short- and Long-term Outcomes in Surgical Management of Adult Choledochal Cysts: Ten-year Experience of a Tertiary Care Centre in Karnataka, India

Abstract

Introduction: Choledochal cysts in adults are rare, as most are diagnosed in childhood. The concern for malignancy in adults adds to the expenses associated with evaluation and management. A aetiology can be congenital or acquired. Acquired biliary wall thinning, caused by the reflux of pancreatic juice, can be a contributing factor in adults. Long-term follow- up after surgery is essential to optimise the treatment. However, not many studies have documented the long-term outcomes of surgery. Aim: To study the short- and long-term outcomes of patients undergoing surgery for adult choledochal cysts {choledochal cyst excision and Hepaticojejunostomy (HJ)}. Materials and Methods: This was a retrospective cohort study of patients aged 18 years and older with choledochal cysts who were diagnosed and operated on between 2012 and 2022 in the Department of Surgical Gastroenterology, Bangalore Medical College and Research Institute (BMCRI), Bengaluru, Karnataka, India. Patients were diagnosed using imaging and subjected to open choledochal cyst excision and HJ. Outcomes like morbidity and mortality associated with the procedure, both in the short- term and long-term, were studied. Continuous variables like age were represented as mean±standard deviation, while categorical variables (such as CBD diameter) were represented as percentages/proportions. Statistical Package for the Social Sciences (SPSS) (version 25.0) was used for statistical analyses. Results: A total of 128 patients were included in the study, with a mean age of 48.92±16.20 years. Type I cysts were seen in 61.72% of the cases, while Type IV A constituted 38.28%. The mean diameter of the Common Bile Duct (CBD) in the study sample was 23.13±14.88 mm, with fusiform dilatation. Endoscopic Retrograde Cholangiopancreatography (ERCP) with stenting/stone clearance was performed in 41 patients. Short-term complications occurred in 48 (37.5%) patients, with Surgical Site Infection (SSI) being the most common early complication. Early postoperative mortality was observed in one patient (0.78%), On long-term follow-up of 83 patients, mortality occurred in six patients. A total of 18 patients complained of abdominal pain during long-term follow-up. Conclusion: Choledochal cyst still remains a significant surgical disease in the adult population, especially in a tertiary care centre. Timely surgical intervention is essential to prevent the short- and long-term complications associated with this condition.