A comparative study of childhood versus adult-onset biliary complications following pediatric choledochal cyst surgery

Abstract

Objective: To investigate the clinical characteristics and management of biliary complications in pediatric and adult patients who underwent choledochal cysts (CDCs) surgery in childhood.

Methods: A retrospective cohort study was conducted at Beijing Tsinghua Changgung Hospital, including 34 patients who developed biliary complications after undergoing CDC surgery during childhood. Patients were stratified into two groups: Group A (childhood-onset, < 18 years, n = 14) and Group B (adult-onset, ≥ 18 years, n = 20). Clinical presentation, imaging, laboratory findings, surgical history and treatment were analyzed.

Results: The median interval from initial CDC surgery to complication onset was significantly shorter in Group A than in Group B (1.5 vs. 15.0 years; p < 0.001). The primary presentation of biliary complications in both groups were cholangitis, with no significant differences in liver function or bilirubin levels. Biliary strictures were the predominant cause in children (85.7% vs. 36.8%; p = 0.011), whereas adult patients more commonly exhibited non-obstructive intrahepatic bile duct dilation (63.2% vs. 14.3%; p = 0.011) and intrahepatic stones (73.7% vs. 28.6%; p = 0.015). Hilar ductoplasty with hepaticojejunostomy revision was the primary surgical strategy in children (85.7% vs. 11.8%; p < 0.001), while adults often required partial hepatectomy combined with biliary reconstruction (82.4% vs. 0%; p < 0.001).Two adults developed biliary malignancies > 30 years postoperatively-adenocarcinoma after cystoduodenostomy and cholangiocarcinoma after hepaticojejunostomy.

Conclusions: Biliary complications following childhood CDC surgery may arise either early in life or decades later, with differing etiologies and surgical approaches depending on age at presentation. Timely recognition and individualized surgical management are essential, and lifelong follow-up is warranted due to the risk of late complications, including malignancy.

Keywords: Biliary complications; Biliary stricture; Choledochal cyst; Intrahepatic bile duct dilation; Partial hepatectomy.