Intrahepatic ductoplasty effectively corrects the ductal dilatation in Todani type IV-A choledochal cyst in children

Primary ductal stricture and intrahepatic duct dilatation are characteristic features in Todani type IV-A choledochal cysts (CDC) and necessitate thorough evaluation and management during surgical treatment. This study aimed to present our experience with ductoplasties for type IV-A CDCs with primary ductal strictures. Between June 2015 and June 2022, 54 patients were reviewed. Primary ductal strictures were identified, and ductoplasties were performed individually. The demographic characteristics, imaging examinations, postoperative outcomes, and complications were evaluated. Among enrolled patients, 36 (66.66%) had strictures at the exit of the common hepatic duct (CHD), 13 (24.07%) had strictures at the exit of the left hepatic duct (LHD) and/or right hepatic duct (RHD), 4 (7.41%) had strictures at the exit of the CHD, with LHD and/or RHD, and 1 (1.85%) patient had strictures at the level 2 or more intrahepatic biliary duct. The median follow-up period was 5.20 years. The dilated intrahepatic ducts returning to a normal size occurred in 52 (96.30%) patients. Two (3.70%) patients experienced anastomosis leakage and required surgical repair 3 similar to 5 days later. Liver function normalized within 1 year postoperatively. It is safe and effective to perform ductoplasties for primary ductal strictures in Todani type IV-A CDCs.