# Choledochal Cyst — GCMD Library living collection

Everything in the library about choledochal cyst — built automatically from dossiers that name it.

Updated: n/a · 5 episodes · 134 cited statements

## Episodes
### Fundamentals
- [Choledochal Cysts: In Brief with Dr. Alexander Bondoc](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439) — podcast · 16:55 · [machine version](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439.md)

### Surgical Management
- [Update Course Rewind: Intraoperative Radiation Safety 2022](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609) — video · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609.md)
- [2025 Pediatric Surgery Update Course - Robotics in Pediatric Surgery: Which indications benefit the most?](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896) — video · 18:17 · [machine version](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896.md)

### Evidence & Research
- [Outcomes of laparoscopic versus open resection of pediatric choledochal cyst](https://origin-library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640) — video · 0:54 · [machine version](https://origin-library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640.md)

### In-Depth Reviews
- [Choledochal Cyst Podcast](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310) — podcast · 22:07 · [machine version](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=0) Definition, Epidemiology, and Etiology of Choledochal Cysts (Ep 1)
- [2:01](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=121) Tadani Classification of Choledochal Cysts (Ep 1)
- [3:20](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=200) Clinical Presentation and Differential Diagnosis (Ep 1)
- [5:41](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=341) Diagnostic Workup (Ep 1)
- [7:53](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=473) Indications for Surgery and Malignancy Risk (Ep 1)
- [11:08](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=668) Surgical Goals and Type-Specific Approaches (Ep 1)
- [13:16](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=796) Surgical Technique for Type 1 and 4 Cysts (Ep 1)
- [18:40](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1120) Postoperative Management and Long-Term Outcomes (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=0) Introduction and epidemiology of choledochal cysts (Ep 2)
- [1:14](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=74) Todani classification, etiology, and diagnostic workup (Ep 2)
- [7:23](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=443) Indications for surgery and treatment goals (Ep 2)
- [12:08](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=728) Type-specific surgical techniques and reconstruction (Ep 2)
- [16:12](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=972) Postoperative management and long-term follow-up (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=0) Introduction to radiation safety in pediatric surgery (Ep 3)
- [0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=27) Port placement scenario and fluoroscopy best practices (Ep 3)
- [2:55](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=175) Practical communication with fluoroscopy technicians (Ep 3)
- [3:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=199) Choledochal cyst scenario and shielding misconceptions (Ep 3)
- [5:21](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=321) Practical considerations for under-patient shielding (Ep 3)
- [6:14](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=374) Closing remarks (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=0) Study overview: open vs laparoscopic choledochal cyst resection (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=0) Introduction and audience survey on robotic surgery adoption (Ep 5)
- [2:51](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=171) Advantages of robotic surgery and learning curve comparison (Ep 5)
- [7:16](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=436) Specific indications and technical considerations (Ep 5)
- [11:20](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=680) Debate on clinical evidence, training implications, and future technology (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Choledochal cyst is a congenital cystic dilation of the biliary tree. — Alex Bondoc (clinical) [Ep 1 · 0:29](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=29)
- Incidence of choledochal cysts in the Western world is about 1 in 100,000. — Alex Bondoc (epidemiological) [Ep 1 · 0:36](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- In Eastern Asia, choledochal cyst incidence is 1 in 13,000. — Alex Bondoc (epidemiological) [Ep 1 · 0:36](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- Choledochal cysts are three to four times more likely in females than in males. — Alex Bondoc (epidemiological) [Ep 1 · 0:36](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- There is no genetic predisposition to choledochal cysts, but some genes including PKD1 have been identified in limited studies for type 5 choledochal cysts. — Alex Bondoc (clinical) [Ep 1 · 0:36](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- The most common classification system for choledochal cysts was developed by a surgeon named Tadani in Japan and includes five types. — Alex Bondoc (clinical) [Ep 1 · 1:10](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- For types 1 and 4 choledochal cysts, the etiology is likely embryologic, relating to pancreaticobiliary duct junction (pancreaticobiliary malunion), which creates a long common channel of the pancreaticobiliary duct. — Alex Bondoc (clinical) [Ep 1 · 1:10](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- Reflux of pancreatic enzymes from the head of the pancreas back into the biliary tree causes inflammation, degeneration, and epithelial changes in types 1 and 4 choledochal cysts. — Alex Bondoc (clinical) [Ep 1 · 1:10](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- In type 5 choledochal cysts, genetic mutation might predispose to more diffuse dilation of both the intra- and extrahepatic biliary trees. — Alex Bondoc (clinical) [Ep 1 · 1:10](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- Type 1 choledochal cyst is a dilation of the extrahepatic common bile duct only, which can be fusiform or saccular. — Alex Bondoc (clinical) [Ep 1 · 2:05](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- Type 2 choledochal cyst is a small diverticulum off of the common bile duct. — Alex Bondoc (clinical) [Ep 1 · 2:05](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- Type 3 choledochal cyst is a choledochocele affecting the portion of the common bile duct in the wall of the duodenum. — Alex Bondoc (clinical) [Ep 1 · 2:05](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- Type 4a choledochal cyst consists of multiple cysts in both the intra- and extrahepatic biliary tree. — Alex Bondoc (clinical) [Ep 1 · 2:05](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- Type 4b choledochal cyst consists of multiple cysts in the extrahepatic biliary tree only. — Alex Bondoc (clinical) [Ep 1 · 2:05](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- Type 5 choledochal cyst is intrahepatic only and diffusely throughout, called Caroli's disease, which can be diffuse or limited to one lobe or one hemi-liver. — Alex Bondoc (clinical) [Ep 1 · 2:05](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- In younger children such as infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound for other causes. — Alex Bondoc (clinical) [Ep 1 · 3:25](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- In children, choledochal cysts often present with symptoms consistent with cholangitis, such as jaundice or fever. — Alex Bondoc (clinical) [Ep 1 · 3:25](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- Patients with choledochal cysts can have a palpable right upper quadrant mass. — Alex Bondoc (clinical) [Ep 1 · 3:25](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- The triad of jaundice, fever, and palpable right upper quadrant mass (Charcot's triad) is incredibly uncommon as a presentation of choledochal cysts. — Alex Bondoc (clinical) [Ep 1 · 3:25](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- Giant choledochal cysts in small children can perforate and present with biliary ascites. — Alex Bondoc (clinical) [Ep 1 · 3:25](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- Giant choledochal cysts can be diagnosed prenatally on week 20 ultrasounds. — Alex Bondoc (clinical) [Ep 1 · 3:25](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- Prenatally diagnosed choledochal cysts require fetal consultation at a fetal surgery center for establishment of care and counseling, because cystic biliary atresia must be ruled out postnatally. — Alex Bondoc (guideline) [Ep 1 · 3:25](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- A recent citation demonstrated that if a choledochal cyst was diagnosed prenatally and was larger than 4.5 centimeters at the 20-week anatomy scan, there was a higher rate of postnatal symptomatology, suggesting these patients may benefit from earlier intervention. — Alex Bondoc (clinical) [Ep 1 · 3:25](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- Differential diagnosis for a one-year-old presenting with jaundice includes problems with the pancreatic or biliary tree, stone disease (choledocholithiasis, cholelithiasis), gallstone pancreatitis, and choledochal cyst. — Alex Bondoc (clinical) [Ep 1 · 5:12](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=312)
- A one-year-old with jaundice is a little old for biliary atresia, which is usually considered in an infant. — Alex Bondoc (clinical) [Ep 1 · 5:12](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=312)
- Physical exam findings to look for in suspected choledochal cyst include jaundice or scleral icterus and, in younger children, a palpable abdominal mass. — Alex Bondoc (clinical) [Ep 1 · 5:46](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- Labs to check for suspected choledochal cyst include liver function tests (total, direct, and indirect bilirubin levels) and possibly a CBC to look for evidence of cholangitis or infection. — Alex Bondoc (clinical) [Ep 1 · 5:46](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- The major initial screening imaging test for choledochal cyst is an abdominal ultrasound. — Alex Bondoc (clinical) [Ep 1 · 5:46](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- Liver biopsy is not typically needed for older patients with reliable ultrasound imaging, but becomes critical in neonates or newborns to rule out cystic biliary atresia variant. — Alex Bondoc (clinical) [Ep 1 · 6:25](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=385)
- CT scan is commonly used for choledochal cyst workup because of the ease with which young children can be scanned. — Alex Bondoc (clinical) [Ep 1 · 6:47](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- MRCP is useful for choledochal cysts with hilar or intrahepatic disease to understand the extent of cystic change and to identify variant biliary anatomy, which occurs in 15 to 20% of patients. — Alex Bondoc (clinical) [Ep 1 · 6:47](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- ERCP can be used for both diagnostic and therapeutic purposes in choledochal cysts, depending on prior scan findings and the type of cyst. — Alex Bondoc (clinical) [Ep 1 · 6:47](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- There are no non-surgical treatment options for choledochal cysts. — Alex Bondoc (clinical) [Ep 1 · 8:00](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- Choledochal cysts require surgery due to the risk of recurrent cholangitis from biliary stasis and superinfection. — Alex Bondoc (clinical) [Ep 1 · 8:00](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- Type 1 and type 4 choledochal cysts with pancreaticobiliary malunion carry approximately an 8% lifetime risk of hepatobiliary malignancy, most specifically cholangiocarcinoma and gallbladder cancer. — Alex Bondoc (clinical) [Ep 1 · 8:00](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- Studies estimate the lifetime risk of malignancy in choledochal cysts to be anywhere from 6% to 30%. — Alex Bondoc (clinical) [Ep 1 · 8:00](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- Even after surgical resection of choledochal cysts, some studies suggest there is still about a 4% lifetime risk of malignancy, requiring lifelong surveillance. — Alex Bondoc (clinical) [Ep 1 · 8:00](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- If a patient with choledochal cyst presents with active infection, pancreatitis, or cholangitis, the best approach is to cool the patient off and treat the underlying process before scheduling surgery after sufficient recovery. — Alex Bondoc (clinical) [Ep 1 · 9:16](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=556)
- For incidentally found choledochal cysts, surgery should be scheduled sooner rather than later, when it makes sense for the family schedule. — Alex Bondoc (opinion) [Ep 1 · 9:16](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=556)
- Preoperative workup for choledochal cyst surgery includes laboratory values to ensure no other disease process is impairing liver function, and imaging (ultrasound and CT scan are often sufficient). — Alex Bondoc (clinical) [Ep 1 · 10:14](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=614)
- MRCP is recommended preoperatively if there is any question about the patient's anatomy or if the patient has a very proximal choledochal cyst or dilation into the hepatic ducts. — Alex Bondoc (clinical) [Ep 1 · 10:14](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=614)
- The surgical goal for choledochal cyst repair is complete excision of the cyst. — Alex Bondoc (clinical) [Ep 1 · 11:13](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- For type 1 and type 4 choledochal cysts, the goal is to remove as much of the duct as possible, taking the duct all the way down behind or into the head of the pancreas to where it tapers, to avoid leaving remnant cyst. — Alex Bondoc (clinical) [Ep 1 · 11:13](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- For type 1 and type 4 choledochal cysts, biliary drainage reconstruction often includes a Roux-en-Y hepaticojejunostomy, but a hepaticoduodenostomy is also an option. — Alex Bondoc (clinical) [Ep 1 · 11:13](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- Type 2 choledochal cyst can be treated by simple removal of the diverticulum at its neck with repair of the common bile duct. — Alex Bondoc (clinical) [Ep 1 · 11:13](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- Type 3 choledochal cyst (limited choledochocele) can be treated with ERCP and sphincterotomy. — Alex Bondoc (clinical) [Ep 1 · 11:13](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- If type 3 choledochal cyst involves the wall of the duodenum, transduodenal resection options exist, and biopsy of the choledochocele mucosa is important because biliary epithelium exposed to intestinal secretions could become malignant. — Alex Bondoc (clinical) [Ep 1 · 11:13](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- Type 5 choledochal cyst (Caroli's disease) management depends on disease extent: if limited to an anatomic part of the liver, resection may be appropriate; if diffuse throughout the liver without adequate functional remnant, transplantation may be necessary. — Alex Bondoc (clinical) [Ep 1 · 11:13](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- For choledochal cyst surgery in children less than 2 years old, a transverse incision or right subcostal incision is preferred; for older children, an upper midline incision is a viable option. — Alex Bondoc (clinical) [Ep 1 · 13:19](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- During choledochal cyst dissection, hepatic arteries are medial and the portal vein is posterior to the cyst. — Alex Bondoc (clinical) [Ep 1 · 13:19](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- Dr. Bondock performs an intraoperative cholangiogram through the gallbladder to understand where the tapering of the distal cyst occurs to avoid leaving remnant cyst. — Alex Bondoc (clinical) [Ep 1 · 13:19](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- For Roux-en-Y hepaticojejunostomy reconstruction, Dr. Bondock goes about 15 to 20 centimeters distal from the ligament of Treitz, performs a two-layer jejunojejunostomy, and does a hepaticojejunostomy with interrupted 5-0 or 6-0 Maxon suture. — Alex Bondoc (clinical) [Ep 1 · 13:19](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- Dr. Bondock performs the Roux-en-Y limb retrocolic and closes the small bowel mesentery. — Alex Bondoc (clinical) [Ep 1 · 13:19](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- For type 2 choledochal cyst, once the cyst is tapered down to the common bile duct, the neck is resected and the common bile duct is repaired with interrupted absorbable suture without leaving a T-tube. — Alex Bondoc (clinical) [Ep 1 · 16:47](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- Type 3 choledochal cyst can be approached endoscopically with ERCP and sphincterotomy, but if the lesion is large and obstructing the common duct, a transduodenal approach is needed, sometimes with preoperative stents to separate it from the duodenum. — Alex Bondoc (clinical) [Ep 1 · 16:47](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- Type 5 choledochal cyst (Caroli's disease) can be addressed surgically with liver resection if cystic disease is limited to one hemi-liver with adequate liver remnant and preserved biliary outflow, but if diffuse throughout the liver, liver transplantation may be necessary. — Alex Bondoc (clinical) [Ep 1 · 16:47](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- Postoperative considerations for choledochal cyst surgery include enteric drainage and awaiting return of bowel function. — Alex Bondoc (clinical) [Ep 1 · 18:45](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Dr. Bondock typically places an NG tube postoperatively because of the new jejunojejunostomy, but tries to remove it the day after surgery. — Alex Bondoc (clinical) [Ep 1 · 18:45](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Drains are placed postoperatively to assess for biliary leaks from the new hepatoenteric anastomosis and are typically removed once the patient is tolerating a regular diet. — Alex Bondoc (clinical) [Ep 1 · 18:45](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Institutionally, patients are placed on a choleretic like Actigall and cholangitis prophylaxis (daily Bactrim) for three to six months after choledochal cyst surgery. — Alex Bondoc (clinical) [Ep 1 · 18:45](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Short-term to long-term surgical complications of choledochal cyst surgery include anastomotic stricture, small bowel obstruction from intra-abdominal surgery, reflux gastritis, and recurrent cholangitis. — Alex Bondoc (clinical) [Ep 1 · 18:45](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Lifelong follow-up is needed for choledochal cyst patients because of the possibility of developing future malignancy even after resection of the cyst. — Alex Bondoc (clinical) [Ep 1 · 18:45](https://origin-library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- In the Western world the incidence of choledochal cysts is about one in 100,000. — Alex Bondoc (epidemiological) [Ep 2 · 1:14](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=74)
- In Asia, specifically Eastern Asia, choledochal cyst incidence is one in 13,000. — Alex Bondoc (epidemiological) [Ep 2 · 1:35](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=95)
- Choledochal cysts have a female predominance. — Alex Bondoc (epidemiological) [Ep 2 · 1:14](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=74)
- For Todani types 1 and 4, the etiology is likely embryologic relating to the pancreaticobiliary duct junction (pancreaticobiliary malunion). — Alex Bondoc (clinical) [Ep 2 · 2:10](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=130)
- Pancreaticobiliary malunion is just one theory for the etiology of choledochal cysts and doesn't explain the higher incidence in the Far East. — Alex Bondoc (opinion) [Ep 2 · 2:40](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=160)
- In adults, the common channel (confluence of biliary and pancreatic ducts) is supposed to be less than 0.9 centimeters, but in pediatric patients any common channel is abnormal. — Alex Bondoc (clinical) [Ep 2 · 3:05](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=185)
- Reflux of pancreatic enzymes into the biliary tree causes inflammation, degeneration, and epithelial changes. — Alex Bondoc (clinical) [Ep 2 · 3:30](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=210)
- Type 5 choledochal cyst (Caroli's disease) has an associated genetic mutation in PKHD1. — Alex Bondoc (clinical) [Ep 2 · 4:00](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=240)
- Type 1 choledochal cyst is a dilation of the extrahepatic common bile duct only, either fusiform or saccular. — Alex Bondoc (clinical) [Ep 2 · 4:40](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=280)
- Type 2 choledochal cyst is a small diverticulum off the common bile duct. — Alex Bondoc (clinical) [Ep 2 · 5:00](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=300)
- Type 3 choledochal cyst (choledochocele) is a dilation of the common bile duct in the wall of the duodenum. — Alex Bondoc (clinical) [Ep 2 · 5:10](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=310)
- Type 4a choledochal cyst consists of multiple cysts in both the intra- and extrahepatic biliary tree. — Alex Bondoc (clinical) [Ep 2 · 5:25](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=325)
- Type 4b choledochal cyst consists of multiple cysts in the extrahepatic biliary tree only. — Alex Bondoc (clinical) [Ep 2 · 5:40](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=340)
- Type 5 choledochal cyst (Caroli's disease) has diffuse cystic dilation that can be throughout the liver or limited to one lobe. — Alex Bondoc (clinical) [Ep 2 · 5:50](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=350)
- In younger children and infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound. — Alex Bondoc (clinical) [Ep 2 · 6:10](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=370)
- In children, choledochal cysts often present with symptoms consistent with cholangitis such as jaundice or fever, and patients can have a palpable right upper quadrant mass. — Alex Bondoc (clinical) [Ep 2 · 6:25](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=385)
- Giant choledochal cysts that children are born with can perforate and present with biliary ascites. — Alex Bondoc (clinical) [Ep 2 · 6:55](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=415)
- Large choledochal cysts can be identified on 20-week fetal ultrasound and should be referred to a fetal center for workup and close monitoring after birth. — Alex Bondoc (guideline) [Ep 2 · 7:10](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=430)
- In neonates or newborns with suspected choledochal cyst, liver biopsy is critical to rule out the cystic biliary atresia variant. — Alex Bondoc (guideline) [Ep 2 · 8:40](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=520)
- While ultrasound and labs are sufficient to diagnose a choledochal cyst, axial imaging such as CT scan is needed before taking patients to the operating room. — Alex Bondoc (guideline) [Ep 2 · 9:00](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=540)
- MRCP is useful for operative planning when there are questions about anatomic details, specifically for high disease (into the hilum or intrahepatic) to assess the extent of cystic change. — Alex Bondoc (clinical) [Ep 2 · 9:20](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=560)
- Up to 15 to 20 percent of choledochal cyst patients have some kind of variant biliary tract anatomy. — Alex Bondoc (epidemiological) [Ep 2 · 7:31](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=451)
- Dr. Bondoc constructs Roux-en-Y hepaticojejunostomies by going 15 to 20 centimeters distal from the ligament of Treitz, performing a jejunojejunostomy in two layers if child size allows, then doing a hepaticojejunostomy with interrupted 5-0 or 6-0 Maxon suture. — Alex Bondoc (clinical) [Ep 2 · 12:08](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=728)
- Dr. Bondoc does not usually biopsy the liver unless there is something obvious, but does close the mesenteric defect. — Alex Bondoc (opinion) [Ep 2 · 13:20](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=800)
- Type 2 choledochal cysts require resection of the diverticulum and primary repair of the common bile duct. — Alex Bondoc (clinical) [Ep 2 · 13:35](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=815)
- For type 3 choledochal cysts, ERCP and sphincterotomy can be therapeutic in some cases. — Alex Bondoc (clinical) [Ep 2 · 13:50](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=830)
- If a type 3 choledochal cyst is large and obstructing the common duct, a transduodenal approach is often needed to resect the cyst and reconstruct the outflow, sometimes with preoperative stents placed via ERCP. — Alex Bondoc (clinical) [Ep 2 · 14:05](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=845)
- Type 5 choledochal cysts may require liver transplant if cystic disease is diffuse throughout the liver. — Alex Bondoc (clinical) [Ep 2 · 14:35](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=875)
- If type 5 cystic burden is limited to one hemi-liver or allows for resection with adequate liver remnant and preserved biliary outflow, it can be addressed surgically with liver resection. — Alex Bondoc (clinical) [Ep 2 · 14:55](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=895)
- Postoperatively, choledochal cyst patients have an NG tube for about 24 hours to protect the jejunal anastomosis and have temporary biliary drains until eating a regular diet to catch any leaks from the hepaticojejunostomy. — Alex Bondoc (clinical) [Ep 2 · 15:20](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=920)
- Postoperative complications for choledochal cyst surgery include recurrent cholangitis due to the connection between the biliary tree and enteric system, anastomotic stricture, small bowel obstruction, and reflux gastritis. — Alex Bondoc (clinical) [Ep 2 · 15:50](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=950)
- Prophylactically, choledochal cyst patients are put on Bactrim postoperatively; Actigall can also be helpful but may be institution-specific. — Alex Bondoc (clinical) [Ep 2 · 16:00](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=960)
- Lifelong follow-up is critical for choledochal cyst patients because of the possibility of developing future malignancy even after resection of the cyst. — Alex Bondoc (guideline) [Ep 2 · 16:12](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=972)
- Four out of approximately 30 attendees perform robotic surgery; another 12 have robot access but do not use it — Juan Gurria (epidemiological) [Ep 5 · 0:24](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=24)
- Robotic instruments have seven degrees of freedom compared to six for the human hand — Juan Gurria (clinical) [Ep 5 · 0:24](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=24)
- Learning curve for basic proficiency is 20-30 cases for laparoscopy versus 10-15 cases for robotics — Juan Gurria (clinical) [Ep 5 · 2:51](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=171)
- Initial cost premium for robotic surgery is approximately $4000 per case in most institutions — Juan Gurria (clinical) [Ep 5 · 2:51](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=171)
- Each additional 15 minutes of operative time costs the same for robotic and laparoscopic surgery — Juan Gurria (clinical) [Ep 5 · 2:51](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=171)
- Room turnover time for robotic cases can be reduced to 30 minutes with trained personnel — Juan Gurria (clinical) [Ep 5 · 2:51](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=171)
- There is no FDA approval for robotic systems in pediatric surgery — Juan Gurria (guideline) [Ep 5 · 3:38](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=218)
- All pediatric surgery fellowships are integrating robotic training — Juan Gurria (epidemiological) [Ep 5 · 2:51](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=171)
- Robotic surgery shows lower conversion to open rates compared to laparoscopy in colorectal cases — Juan Gurria (clinical) [Ep 5 · 2:51](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=171)
- Median arcuate ligament release should not be performed laparoscopically or open anymore due to difficulty accessing the angle near the celiac trunk — Juan Gurria (opinion) [Ep 5 · 3:15](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=195)
- Robotic surgery is not recommended for appendectomy — Juan Gurria (opinion) [Ep 5 · 7:16](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=436)
- Choledochal cyst is a perfect case for robotic surgery — Juan Gurria (opinion) [Ep 5 · 0:24](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=24)
- Adrenalectomy for neuroblastoma confined to the adrenal is a perfect robotic case — Juan Gurria (opinion) [Ep 5 · 0:24](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=24)
- ICG fluorescence allows visualization of adrenal arteries supplied by renal, diaphragmatic, and aortic vessels — Juan Gurria (clinical) [Ep 5 · 7:16](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=436)
- The next generation of surgeons will not be proficient in laparoscopy if robotic surgery becomes dominant in training — Todd Ponsky (opinion) [Ep 5 · 11:42](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=702)
- Robotic surgery is not a standard of care but a tool to aid efficiency and access to difficult angles — Juan Gurria (opinion) [Ep 5 · 12:55](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=775)
- Studies comparing robotic to laparoscopic surgery consistently show equivalence rather than superiority (clinical) [Ep 5 · 14:05](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=845)
- Surgeons trained primarily in robotics cannot tie, sew, or work with 3mm instruments effectively — Juan Gurria (opinion) [Ep 5 · 15:59](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=959)
- Patients are seeking out centers that offer robotic surgery, particularly in adult centers — Todd Ponsky (epidemiological) [Ep 5 · 16:50](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=1010)
- ICG fluorescence in choledochal cyst surgery allows visualization far back to the head of the pancreas to achieve proper tapering, decreasing future cancer risk — Juan Gurria (clinical) [Ep 5 · 17:14](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=1034)
- New robotic systems with tactile sensors reduce force application by 83% — Juan Gurria (clinical) [Ep 5 · 17:14](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=1034)
- Best practice guidelines for fluoroscopy are not routinely taught to surgeons in the United States. — Mary Edwards (opinion) [Ep 3 · 0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=27)
- Best practice fluoroscopy includes positioning the patient as close as possible to the image intensifier or flat plate detector. — Mary Edwards (guideline) [Ep 3 · 0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=27)
- In standard C-arm configuration, raising the bed as far as possible brings the patient close to the image intensifier. — Mary Edwards (clinical) [Ep 3 · 0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=27)
- Pulse mode is a feasible option in most pediatric surgery fluoroscopy applications. — Mary Edwards (clinical) [Ep 3 · 0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=27)
- Every time the magnification setting is used on the fluoroscopy machine, it significantly increases the radiation dose to both the patient and the room. — Mary Edwards (clinical) [Ep 3 · 0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=27)
- Collimation focuses the x-ray beam to a specific area, which increases image detail and clarity. — Mary Edwards (clinical) [Ep 3 · 0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=27)
- Collimation decreases the total radiation dose to the patient because the surface area getting irradiated is smaller. — Mary Edwards (clinical) [Ep 3 · 0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=27)
- Collimation decreases radiation dose to the room. — Mary Edwards (clinical) [Ep 3 · 0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=27)
- In small patients, overexposure can occur if collimation is not used appropriately. — Mary Edwards (clinical) [Ep 3 · 0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=27)
- By convention, the x-ray source in the C-arm is placed below the table. — Mary Edwards (clinical) [Ep 3 · 3:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=199)
- The patient and table protect personnel in the room from radiation when the x-ray source is below the table. — Mary Edwards (clinical) [Ep 3 · 3:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=199)
- Placing a radiation shield drape on top of a patient does nothing to protect them from radiation because the x-ray source is below the table. — Mary Edwards (clinical) [Ep 3 · 3:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=199)
- Fluoroscopy machines utilize automatic brightness control, which increases x-ray energy when something blocks the beam from reaching the image intensifier. — Mary Edwards (clinical) [Ep 3 · 3:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=199)
- If a radiation shield is in the fluoroscopy field, automatic brightness control increases radiation exposure to the patient. — Mary Edwards (clinical) [Ep 3 · 3:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=199)
- If shielding is used, it must be placed below the patient to be effective. — Mary Edwards (guideline) [Ep 3 · 3:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=199)
- Fluoroscopy technicians know that shields should be placed below the patient, but they enter the room after drapes are placed and don't know where shields are located. — Mary Edwards (clinical) [Ep 3 · 3:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=199)
- Shielding can be placed underneath the gel pad or similar patient positioning device. — Mary Edwards (clinical) [Ep 3 · 5:21](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=321)
- Shielding underneath the patient is probably problematic for multiple reasons including increased potential for increased exposure if the right image is not obtained. — Todd Ponsky (opinion) [Ep 3 · 5:49](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=349)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018. — Ellen Encisco summarizing a resource [Ep 4 · 0:13](https://origin-library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=13)
- The majority of patients underwent open resection. — Ellen Encisco summarizing a resource [Ep 4 · 0:24](https://origin-library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=24)
- Patients who underwent open resection were more likely to have a Roux-en-Y hepaticojejunostomy. — Ellen Encisco summarizing a resource [Ep 4 · 0:24](https://origin-library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=24)
- Patients who underwent laparoscopic resection were more likely to have a hepaticoduodenostomy. — Ellen Encisco summarizing a resource [Ep 4 · 0:24](https://origin-library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=24)
- Patients who underwent open resection were more likely to have a longer length of hospital stay. — Ellen Encisco summarizing a resource [Ep 4 · 0:39](https://origin-library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=39)
- Patients who underwent open resection were more likely to have more complications. — Ellen Encisco summarizing a resource [Ep 4 · 0:39](https://origin-library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=39)
- Patients who underwent open resection had higher total costs. — Ellen Encisco summarizing a resource [Ep 4 · 0:39](https://origin-library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=39)
- Choledochal cysts are a congenital dilation of the biliary tree. — Alex Bondoc summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=0)
- A recent study showed that if a choledochal cyst was diagnosed prenatally and was larger than 4.5 centimeters at the 20-week anatomy scan, there was a higher rate of postnatal symptoms, suggesting these patients may benefit from earlier intervention. — Alex Bondoc summarizing a resource [Ep 2 · 7:30](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=450)
- Surgery is the only true treatment option for choledochal cysts. — The host summarizes what Dr. Alex Bondoc said [Ep 2 · 8:03](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=483)
- The risk of developing cholangiocarcinoma in choledochal cyst patients can be as high as 26 percent according to some studies. — The host summarizes what Dr. Alex Bondoc said [Ep 2 · 8:40](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=520)
- Even after surgical resection of choledochal cysts, some studies suggest there is still about a 4 percent lifetime risk of malignancy, requiring lifelong surveillance. — The host summarizes what Dr. Alex Bondoc said [Ep 2 · 9:00](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=540)
- Patients presenting acutely with choledochal cysts can have pancreatitis or cholangitis, and infection/inflammation can make for a hostile surgical field. — The host summarizes what Dr. Alex Bondoc said [Ep 2 · 9:25](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=565)
- If a choledochal cyst is found incidentally, resection is not an emergency but it is better to schedule surgery sooner rather than later. — The host summarizes what Dr. Alex Bondoc said [Ep 2 · 9:45](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=585)
- For type 1 and type 4 choledochal cysts, the goal is to remove as much of the duct as possible, taking it behind or into the head of the pancreas down to where it tapers, to avoid leaving remnant cysts. — The host summarizes what Dr. Alex Bondoc said [Ep 2 · 10:50](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=650)
- Preoperative MRCP is usually sufficient to identify where the distal cyst tapers behind the pancreas, but intraoperative cholangiogram through the gallbladder is an option if imaging is unclear. — The host summarizes what Dr. Alex Bondoc said [Ep 2 · 11:20](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=680)
- Dr. Bondoc's preference for biliary reconstruction is a Roux-en-Y hepaticojejunostomy, though hepaticoduodenostomy is also an option. — The host summarizes what Dr. Alex Bondoc said [Ep 2 · 11:50](https://origin-library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=710)
- Yuri Kuzlov in Russia has performed over 300 robotic cases — Todd Ponsky summarizing the discussion [Ep 5 · 11:42](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=702)
- General surgery residents report doing 75-80% of minimally invasive surgery robotically — Todd Ponsky summarizing the discussion [Ep 5 · 11:42](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=702)
- Robotic surgery shows equivalent oncologic outcomes in certain tumor surgeries — Todd Ponsky summarizing the discussion [Ep 5 · 15:34](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indicat-10896?t=934)
- Accumulation of radiation exposure from medical imaging in children and healthcare professionals can lead to a large lifetime dose of excess radiation. — Em Gootee summarizes what Dr. Mary Edwards said [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=0)
- Dr. Edwards makes it a point to shield only if the patient is pregnant. — Em Gootee summarizes what Dr. Mary Edwards said [Ep 3 · 6:14](https://origin-library.globalcastmd.com/watch/update-course-rewind-intraoperative-radiation-safety-2022-6609?t=374)

## Changelog
- Sep 25: 2 items added automatically
- Sep 7: 3 items added automatically

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://origin-library.globalcastmd.com/ai