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Updated: Jun 23, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Laparoscopic total intracorporeal correction of choledochal cyst in pediatric population
Soo Min Ahn1, Jang Yong Jun, Woo Jung Lee
1Division of Pediatric Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon Anyang, 431-070 Korea. smahn@hallym.ac.kr
Insights
Laparoscopic surgery for pediatric choledochal cysts is feasible using total intracorporeal Roux-en-Y reconstruction. This technique, including hepaticojejunostomy and jejunojejunostomy, avoids bowel exteriorization and is technically achievable.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Laparoscopic correction of choledochal cysts offers an attractive treatment option.
- Intracorporeal jejunojejunal anastomosis is technically challenging for surgeons.
- This study presents the feasibility of total intracorporeal laparoscopic correction for choledochal cysts.
Purpose of the Study:
- To evaluate the feasibility of total intracorporeal laparoscopic correction of choledochal cysts in pediatric patients.
- To assess the safety and efficacy of laparoscopic Roux-en-Y hepaticojejunostomy and jejunojejunostomy.
- To demonstrate a technique that avoids exteriorization of the bowel.
Main Methods:
- Prospective review of 6 pediatric cases undergoing laparoscopic choledochal cyst excision and total intracorporeal Roux-en-Y reconstruction.
- Utilized an endoscopic gastrointestinal anastomosis device for intracorporeal jejunojejunostomy with hand-sewn reinforcement.
- Evaluated operative time, jejunojejunostomy time, and intra/postoperative events.
Main Results:
- All 6 patients were female, with Type I choledochal cysts, aged 4 months to 7 years.
- Mean total operation time was 275 ± 58 minutes; mean intracorporeal jejunojejunostomy time was 38 ± 10 minutes.
- All patients remained symptom-free during a median follow-up of 3.5 months.
Conclusions:
- Total intracorporeal Roux-en-Y hepaticojejunostomy and jejunojejunostomy are feasible in pediatric laparoscopic choledochal cyst surgery.
- This technique can be performed without the need for bowel exteriorization.
- Laparoscopic correction of choledochal cysts is a viable option for pediatric patients.
Background:
The laparoscopic correction of the choledochal cyst is an attractive treatment option. However, even the skilled surgeons do not prefer the intracorporeal jejunojejunal anastomosis due to the technical difficulties. In this article, we present the feasibility of laparoscopic total intracorporeal correction of the choledochal cyst, including the retrocolic Roux-en-Y hepaticojejunostomy and jejunojejunostomy.
Methods:
A prospective review of 6 cases of consecutive laparoscopic surgery for choledochal cyst in the pediatric population from March 2007 to April 2008 was performed. All patients underwent laparoscopic excision of a choledochal cyst and total intracorporeal Roux-en-Y reconstructions. The intracoporeal jejunojejunostomy was made by introducing an endoscopic gastrointestinal anastomosis device (Endo-GIA; US Surgical, Norwalk, CT) through the umbilical port with hand-sewn reinforcement. We evaluated the patient's age at the time of operation, time taken for total operation, time taken for jejunojejunostomy, and intra- and postoperative events.
Results:
All 6 cases were girls (age ranging from 4 months to 7 years). All had type I choledochal cyst. Five ports were utilized: one telescopic port at the umbilicus, one left subcostal port for liver retraction, two operating ports on the right flank and left side of the umbilicus, and one right-lower quadrant port for the assistant. The mean time for total operation was 275 + or - 58 minutes (range, 210-360). Total intracoroporeal jejunojejunostomy took 38 + or - 10 minutes (range, 25-55). All patients were symptom free during the median follow up of 3.5 months.
Conclusion:
In the pediatric population with choledochal cyst, total intracorporeal Roux-en-Y hepaticojejunostomy and jejunojejunostomy during laparoscopic surgery is feasible without the need for exteriorization of the bowel.