1.What is choledochal cyst? Simple choledochal cyst is a cystic dilatation of the common bile duct, which is the most common type of congenital choledochal cyst, the specific cause of which is still unclear and may be related to abnormal embryonic development. Generally 80% of choledochal cysts develop in childhood, but in recent years, the number of adult-onset cases has gradually increased, among which women account for 70-80%, and the incidence in Asia is significantly higher than that in Europe and America. 2.What kind of symptoms does choledochal cyst have? Choledochal cysts are mostly manifested as abdominal pain, jaundice, fever and other manifestations of acute cholangitis, and those with childhood onset can be accompanied by right upper abdominal mass, and in severe cases, shock and psychiatric symptoms. Those with late stage cancer can have systemic wasting, weakness and anemia. 3.How to diagnose choledochal cyst? Most choledochal cysts can be initially diagnosed by ultrasound, which can show the abnormal cystic dilatation of the common bile duct. Of course, due to the subjective nature of ultrasound and the poor clarity of the images, patients with suspected choledochal cysts are recommended to undergo CT and MRI, which are more objective and accurate for the diagnosis of choledochal cysts and can provide detailed information on the length and diameter of the cyst, the presence of stones within it, the thickening of the local cyst wall and the presence of concurrent intrahepatic choledochal cysts. Most hospitals can complete these examinations within a week on an outpatient basis. 4.How is choledochal cyst treated? Because the academic consensus is that choledochal cysts are easily and almost always eventually cancerous, surgery should be considered as soon as choledochal cysts are diagnosed, regardless of age. Patients are not advised to do any kind of observation follow-up. If the choledochal cyst is found in a non-acute stage, the standard surgical protocol should be choledochal cyst excision + hepatic duct jejunostomy R-Y anastomosis, after which the bile is rerouted from being delivered through the common bile duct to the duodenum to being delivered directly to the upper jejunum via the jejunal loop. The operation usually takes about two to three hours. If the common bile duct cyst is accompanied by acute cholangitis, endoscopic nasobiliary or plastic stent internal drainage can be performed first, and then definitive surgery can be performed after the acute inflammation has subsided. This replaces the past practice of external drainage with a T-tube for stage I surgery. Obviously, the endoscopic technique is now much less traumatic than one more open surgery, with faster recovery and less impact on the patient, and also reduces the difficulty of the second definitive surgery. 5.What kind of choledochal cysts are suitable for laparoscopic treatment? Choledochal cyst excision + hepatic duct jejunostomy R-Y anastomosis used to be open surgery, but in recent years it has been gradually replaced by minimally invasive laparoscopic surgery. Even those with a history of open upper abdominal surgery in the past can now technically consider laparoscopic minimally invasive surgery. Experience has shown that laparoscopic surgery is less traumatic, less painful, faster recovery, shorter hospital stay, and generally three days to remove the stitches, but the cost may be relatively higher due to the use of special laparoscopic punctures and anastomoses. 6.Who are not suitable for laparoscopic surgery? In general, laparoscopic surgery can be considered for all choledochal cysts, but in some cases it will be more difficult and the success rate will be reduced, such as: history of upper abdominal surgery causing adhesions in the upper abdomen and increasing anatomical difficulties, especially those with a history of previous biliary surgery; acute inflammation of choledochal cysts that have not subsided; long-term recurrent cholangitis leading to severe adhesions between the choledochal cysts and surrounding tissues that are poorly demarcated; previous cysts that have not been removed due to choledochal If the cyst has not been resected but only the cyst has been drained by jejunostomy. 7.What are the postoperative precautions? No matter open or laparoscopic surgery, most of the postoperative patients do not need to take special drugs, and they can eat less and more meals in the early stage and gradually increase the amount of meals and meat per meal. The main purpose is to observe whether there is narrowing of the hepatic duct-jejunum anastomosis, whether there is reflux of food into the intrahepatic bile duct and whether there is stone formation in the intrahepatic bile duct. Depending on the situation, CT, MRI and upper gastrointestinal barium meal may be considered. Generally the chance of the above situation is low, and if it happens, it can be corrected by a combination of percutaneous transhepatic puncture technique, endoscopic technique and reoperation. 8.Does choledochal cysts recur? How is it treated after recurrence? If the choledochal cyst is completely removed, recurrence of the cyst rarely occurs. If there is residue in the pancreatic segment of the choledochal cyst, it can lead to gradual enlargement of the cyst or even cancer after surgery, and then another surgery may be needed to eradicate it. If you have been seen locally, please try to bring all the consultation materials, including medical history, laboratory test reports and CT and MRI films, when you come to our clinic, or if you don’t have them for the time being, you can consider coming to our hospital for related examinations, when you can retrieve more thin films in the computer, which may provide more information for our diagnosis. Of course, you can also discuss and consult your condition through my personal webpage, WeChat or telephone, and I will give you a professional and detailed answer as soon as possible and arrange for inpatient surgery within a week.