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Updated: Jul 13, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Laparoscopic leak-free technique for the treatment of choledochal cysts
Pablo Laje1, Horacio Questa, Marcela Bailez
1Department of Pediatric Surgery, National Pediatric Hospital J. P. Garrahan, Buenos Aires, Argentina. laje@email.chop.edu
Insights
This study presents a modified laparoscopic technique for treating pediatric choledochal cysts (CC). The "leak-free" approach, involving temporary hepatic duct sealing and running suture anastomosis, resulted in no bile leaks and excellent outcomes.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Choledochal cysts (CC) are congenital bile duct dilatations requiring surgical intervention.
- Laparoscopic techniques offer potential benefits in pediatric surgery, including reduced morbidity.
Purpose of the Study:
- To evaluate a modified "leak-free" laparoscopic technique for treating type I choledochal cysts in children.
- To assess the safety and efficacy of this technique in terms of operative time, complications, and long-term outcomes.
Main Methods:
- A modified "leak-free" laparoscopic technique was used in 6 pediatric patients with type I CC.
- The technique involved transient complete sealing of the hepatic duct during dissection and a running suture for hepatico-jejuno anastomosis.
- Surgery was performed using three trocars and percutaneous stay-stitches for liver retraction; no drains were used.
Main Results:
- Mean operative time was 335 minutes, with oral feeding initiated at a mean of 44 hours postoperatively.
- Mean hospital stay was 6 days; no postoperative biliary leaks were observed.
- All patients were asymptomatic at a mean 12-month follow-up, with normal liver function and no intrahepatic biliary dilation.
Conclusions:
- The modified laparoscopic approach is suitable for pediatric choledochal cyst treatment.
- Key surgical details, including temporary hepatic duct closure and running suture anastomosis, are crucial for minimizing complications.
- This technique facilitates a clean operative field, potentially reduces operative time, and effectively prevents bile leaks.
Objective:
The aim of this report was to present our experience with a modified surgical technique designed for the treatment of choledochal cysts (CC) in children.
Materials And Methods:
Between June 2004 and February 2005, we operated on 6 patients with a diagnosis of type I CC by means of a "leak-free" technique that consists of a transient complete sealing of the hepatic duct for the duration of the dissection, and a single- or double laparoscopic running suture to build the end-to-side hepatico-jejuno anastomosis. There were 4 females and 2 males, whose age ranged between 45 days and 7 years (median, 45 months). All cases were performed with three trocars plus the scope, and two or three percutaneous stay-stitches to retract the liver. The end-to-side hepatico-jejuno anastomoses were done with 5.0 or 6.0 PDS. We left no drains.
Results:
The mean operative time was 335 minutes, and mean postoperative time to oral feeding was 44 hours. The mean hospital stay was 6 days (range, 5-10). No postoperative biliary leak was observed. A cosmetic result was excellent in all patients. In the follow-up (mean, 12 months), all patients were asymptomatic, had no intrahepatic biliary tree dilation, and had normal liver function tests.
Conclusions:
Based on the results of our series, we think that the laparoscopic approach is suitable for these patients, but some surgical details should be followed to lower the complication rate. First, a temporary closure of the hepatic duct to prevent bile spillage during the dissection is important for keeping the area clean and thus reducing the operative time. Second, the use of a running suture for the hepatico-jejunostomy, even though it may be technically challenging, should always be attempted to avoid postoperative bile leaks in these high-flow anastomoses.