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Updated: Apr 17, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Usefulness of laparoscopic cholecystostomy in children with complicated choledochal cyst
Masaya Yamoto1, Naoto Urushihara, Koji Fukumoto
1Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Insights
Laparoscopic cholecystostomy followed by cyst excision effectively treats complicated choledochal cysts (CC) in children. This minimally invasive approach offers symptom relief and cosmetic benefits for pediatric patients with CC.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Choledochal cysts (CC) in children can cause bile duct obstruction, leading to complications like biliary perforation and pancreatitis.
- Temporary drainage is crucial for stabilizing pediatric patients with complicated CC.
- Conservative treatment may fail, necessitating surgical intervention for symptomatic relief.
Purpose of the Study:
- To evaluate the efficacy and safety of laparoscopic cholecystostomy followed by laparoscopic cyst excision for complicated choledochal cysts in children.
- To assess the procedure's impact on symptom amelioration and patient outcomes.
Main Methods:
- Seven girls with complicated choledochal cysts (CC) underwent emergency laparoscopic cholecystostomy for bile drainage between 2009 and 2013.
- Patients included those with biliary perforation, huge cysts, peribiliary edema, or protein plugs.
- Laparoscopic cyst resection was performed after initial stabilization and evaluation.
Main Results:
- Laparoscopic cholecystostomy successfully ameliorated symptoms like abdominal pain and jaundice in all patients.
- Saline irrigation via cholecystostomy aided in bile duct clearance.
- Protein plugs and gallstones were eliminated during laparoscopic cyst excision.
Conclusions:
- Laparoscopic cholecystostomy followed by laparoscopic cyst excision is a safe and effective treatment for complicated choledochal cysts in children.
- The technique offers cosmetic advantages by utilizing trocar sites for the final excision.
- This combined laparoscopic approach provides a favorable outcome for pediatric CC management.
Introduction:
In children with choledochal cysts (CC), obstruction of the discharge of bile or pancreatic juice is frequently observed, and biliary perforation and severe pancreatitis may occur. In such cases, temporary drainage is necessary to stabilize these patients. We employed laparoscopic cholecystostomy followed by laparoscopic cyst excision in cases with complicated CC.
Methods:
Between 2009 and 2013, emergency laparoscopic cholecystostomy for bile drainage was performed in seven girls with complicated CC in whom conservative treatment failed to ameliorate abdominal pain, vomiting, and jaundice; among these seven patients included two with biliary perforation, one with a huge cyst, and four with peribiliary edema suggestive of impending biliary rupture. Protein plugs in the common channel or the terminal portion of the cyst were present in six patients.
Results:
Amelioration of symptoms, such as abdominal pain and jaundice, was achieved in all patients after laparoscopic cholecystostomy. Saline irrigation of the bile duct via cholecystostomy was commenced 2 days postoperatively. All patients underwent laparoscopic cyst resection after improvement of their general condition and detailed evaluation of the intrahepatic and extrahepatic bile ducts and pancreaticobiliary maljunction. Impacted protein plugs or gallstones were eliminated in all patients by the time of laparoscopic cyst excision.
Conclusion:
Laparoscopic cholecystostomy followed by laparoscopic cyst excision is a useful and safe procedure for the treatment of complicated CC. This technique is also favorable from a cosmetic viewpoint because the resultant wound can be reused as the trocar insertion site at the time of laparoscopic cyst excision.
