Choledochal Cyst

For children with type I cysts, the surgery is called Roux-en-Y hepaticojejunostomy (pronounced roo-enn-WHY hee-PAT-ih-koe-jeh-joo-NOS-tuh-mee). “Hepatic” has to do with the liver. “Jejunum” is the middle segment of the small intestine.

At the time of surgery, we give your child medicine to make them sleep without pain (general anesthesia).

Your child’s surgeon cuts the common bile duct on each side of the cyst and takes out the cyst.

Next the surgeon cuts through the small intestine. The surgeon brings the lower part of the intestine up and sews it to the bile duct. This makes a new complete tube. Bile can now flow from your child’s liver into their intestine.

Then the surgeon cuts a hole in the side of the new tube. The surgeon brings the upper part of the intestine down and sews it to this hole. Now food can move from your child’s stomach into their intestine.

For children with other types of cysts, the surgery may be different. Your child’s surgeon will explain the type of surgery that’s best for your child and will describe the steps to you. In most cases, the purpose of surgery is the same — to take out any cyst that is outside the liver. (Surgery is different for type III cysts, or choledochocele.) If cysts are inside the liver and causing liver problems, your child might need one part (lobe) of their liver removed. This is not common.

Some children can have their surgery through small cuts (“keyhole” incisions) in their belly (laparoscopic surgery, or minimally invasive procedure). The surgeon may do this directly or in some cases may do it using the da Vinci robot. For some children, surgeons need to make one longer incision, called an open approach, in order to reach the cyst and intestine. Your child’s surgeon will explain the method that is best for your child.

After surgery, your child will be in the recovery room for about an hour. Then they will go to a regular hospital room and eventually to home. Usually, children with choledochal cyst stay in the hospital 7 days. This depends on factors like when your child gets back to eating normally and when their pain is well controlled with medicines taken by mouth. Often children need a drain left in the side of their belly after surgery. In most cases, we will remove this before your child goes home.

Your child will have a follow-up visit with the surgeon 2 to 3 weeks after the surgery to make sure their incision is healing well.

After healing from surgery, your child will need to visit the doctor from time to time for regular check-ups and if they have any symptoms. It’s important to make sure their bile keeps flowing well.

If your child has infected bile ducts (cholangitis), the doctor will give your child antibiotics to fight the infection. This may need to be done in the hospital.

We have treated many babies as well as older children with choledochal cysts at Seattle Children’s. Our surgeons are experienced at performing the surgeries these children need to remove their cyst and create good bile flow.

When you come to Seattle Children’s, you have a team of people to care for your child. Along with your child’s surgeon, you are connected with nurses, dietitians, child life specialists and others. We work together to meet all of your child’s health needs and help your family through this experience.

Since 1907, Seattle Children’s has been treating children only. Our team members are trained in their fields and in meeting the unique needs of children. For example, the doctors who give your child anesthesia are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age. Our expertise in pediatrics truly makes a difference for our patients and families.