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

If a patient has a Type 3 choledochal cyst, what surgical option may be performed?

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

2. Transduodenal excision of cyst or Whipple procedure

3. Liver transplant

4. Excise cyst only

The correct answer is: Transduodenal excision of cyst or Whipple procedure

In the management of a Type 3 choledochal cyst, which is characterized by dilation of the common bile duct with a cystic structure at the ampulla, the surgical approach often focuses on the resection of the cyst and restoration of bile flow. The transduodenal excision of the cyst or a Whipple procedure are viable options because they allow for complete removal of the cyst while also addressing any potential complications related to the anatomy of the biliary system. This is essential to prevent further episodes of cholangitis or other complications associated with choledochal cysts, such as biliary obstruction or malignancy. In a Whipple procedure, the pancreas, duodenum, biliary tract, and sometimes a portion of the stomach are resected, providing a comprehensive solution in cases where the cyst is affecting both the bile and pancreatic ducts. The transduodenal approach involves accessing the cyst directly through the duodenum, allowing for cyst resection and reconstruction of the biliary tract. Other surgical options, while they might be considered, do not specifically address the complexities of a Type 3 cyst as effectively as the Whipple procedure or transduodenal excision. Therefore, the focus is on complete exc