American Board of Surgery Qualifying Exam (ABS QE) Practice Test

What is the recommended treatment for a Type 1 choledochal cyst?

1. Excise cyst, and perform Roux-en-Y hepaticojejunostomy

2. Transduodenal excision of cyst

3. Liver resection if possible

4. Liver transplant

The correct answer is: Excise cyst, and perform Roux-en-Y hepaticojejunostomy

In the case of a Type 1 choledochal cyst, which is characterized by an abnormal cystic dilation of the common bile duct, the recommended treatment involves excising the cyst and performing a Roux-en-Y hepaticojejunostomy. This surgical intervention addresses several crucial aspects of managing this condition. Firstly, excising the cyst is essential to remove the potentially diseased tissue that is at risk for complications such as malignancy, cholangitis, and pancreatitis. The Roux-en-Y hepaticojejunostomy procedure is then performed to create a new, bile drainage pathway from the liver, ensuring normal bile flow into the intestine following the removal of the cyst. This anastomosis minimizes the risk of bile duct stricture and provides a safe route for bile drainage. Furthermore, this approach takes into consideration the fact that Type 1 choledochal cysts have a significant risk of associated complications, and excising the cyst while reconstructing the biliary system effectively mitigates these risks. In contrast, transduodenal excision, liver resection, or liver transplant are not the standard approaches for Type 1 choledochal cysts. Transduodenal excision focuses on removing the cyst through the du