In my procedure choledochal cyst excised completly but gallbladder saved with it's vascularity than the gallbladder interposition done between remaining hepatic duct and duodenum.In this procedure minimum dissection,no use of Roux-en-Y, so no jejunal discontinuty.In hepatico-duodenostomy there is more reflux, if gallbladder interposition done chance of reflux will be less.As choledochal cyst excised completly there is least chance of cholangiocarconoma. But question is whether there is any chance of carcinoma of gallbladder?

Yes,not suitable for all cases.Type-1 coledochal cyst is suitable but not so big one.In Roux en-Y there is discontinuity of jejunum,chance of intestinal obstruction,sometimes the Roux-en-Y loop of jejunum become redundant when the child growing and overall there is future long life.

No... I dont think this should be done!! Ideal suregry is excision and Roux en Y hepatico-jejunostomy..

In this case (surgery propsed by you) risk of ascending cholengitis will be unacceptably high and risk of cholengio-cancinoma will be there too!!

I agree with dr TeWari

Rubbish!! The natural history is one of complications; hence complete excision with optimum drainage is procedure of choice.

I agree with TeWari and Patankar!!!

You have a good idea but I think complete excision with GB is better

The natural history is one of complications; hence complete excision with optimum drainage is procedure of choice.

In my experience the excision of choledochal cyst along with gallbladder is the best choice.But I used to do the hepatoenterostomy following the resection with the conical antireflux valve to prevent enterobiliary reflux and ascending cholangitis.If you would like to know this antireflux procedure you can search"The conical antireflux valve.." by Nguyen Huu phung..

Using GB has 2 risks, which is to be avoided in Choledochal cyst surgery.

1. In view of 'field change' risk of malignant transformation, sparing the GB would mean incomplete surgery as it can be a site for future malignancy Ann Hepatol 2014;13(6):819-26

2. GB has never withstood the test of time as conduit for drainage due to frequent problems of stricture Eur J Pediatr Surg. 2001 Feb;11(1):19-23

Preserving gall bladder in such cases, will make the child vulnerable to cholecystitis and potential neoplastic changes.

It is better to sacrifice GB and resume anastomosis between biliary tree and bowel.

Dear Mr. Fahmy, The traditional teaching in managing adult CBD obstructions during my surgical residency was to do a Roux En Y CholedochoJejunostomy for younger patients( ?Younger than 60 years ) and to attempt chodeochojejunostomy in older patients as to prevent cholangitis and development of Malignancy. With the advent of laparoscopy, this scenario has changed and chodedochoduodenostomy is being performed. May be we need to look at the long term results to make sure that this would be safer. This as you suggested is also with leaving behind Gallbladder. Only time will tell. Regards, Satish.