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Updated: Apr 14, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Laparoscopic versus open surgery in children with choledochal cysts: a meta-analysis
Huo-Jian Shen1, Ming Xu, Hong-Yi Zhu
1Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, China.
Insights
Laparoscopic surgery for choledochal cysts offers reduced hospital stays and blood loss compared to open surgery. While operative time is longer, laparoscopic approaches demonstrate safety and efficacy, potentially becoming the preferred method.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Choledochal cysts are congenital biliary anomalies requiring surgical intervention.
- Traditional open cyst excision has been the standard treatment.
- Minimally invasive techniques are increasingly explored for pediatric surgical conditions.
Purpose of the Study:
- To compare the safety and efficacy of laparoscopic versus open cyst excision with hepaticojejunostomy in children.
- To evaluate key perioperative outcomes between the two surgical approaches.
Main Methods:
- A meta-analysis of retrospective studies comparing laparoscopic (LH) and open (OH) choledochal cyst excision.
- Data extracted from electronic databases (PubMed, Embase, etc.) up to November 2014.
- Outcomes analyzed included operative time, blood loss, hospital stay, and postoperative morbidity.
Main Results:
- Laparoscopic surgery (LH) showed significantly longer operative times but reduced postoperative hospital stay, lower intraoperative blood loss, and faster time to food intake compared to open surgery (OH).
- Postoperative morbidity rates were not statistically different between LH and OH groups.
- Seven studies involving 1016 patients (408 LH, 608 OH) were included in the meta-analysis.
Conclusions:
- Laparoscopic surgery is a safe and feasible option for pediatric choledochal cysts, associated with benefits like shorter hospital stays and less blood loss.
- Improved laparoscopic techniques and surgeon experience may position laparoscopy as the preferred treatment for choledochal cysts.
- The study highlights the advantages of minimally invasive approaches in pediatric hepatobiliary surgery.
Objective:
To compare the safety and efficacy between laparoscopic and open cyst excision with hepaticojejunostomy for children with choledochal cysts using meta-analysis.
Methods:
Studies comparing the laparoscopic and the open choledochal cyst excision that met the inclusion criteria for data extraction were identified from electronic databases (PubMed, Embase, Science Citation Index, and the Cochrane Library) up to November 2014. The proceedings of relevant congress were also searched. The outcomes were operative time, intraoperative blood loss, time to food intake, postoperative morbidity and mortality, length of hospital stay. Outcomes were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using RevMan 5.2.
Results:
Seven retrospective studies were finally included, involving a total of 1016 patients, of whom, 408 cases underwent laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy (LH) and 608 cases underwent open cyst excision and Roux-en-Y hepaticojejunostomy (OH). In LH group compared with OH group, the operative time was longer (MD = 59.11, 95% CI 27.61-90.61, P = 0.0002), while the length of postoperative hospital stay was less (MD = -2.01, 95% CI -2.49 to -1.54, P < 0.00001), the intraoperative blood loss was lower (MD = -37.14, 95% CI -66.69 to -7.60, P = 0.01) and time to food intake was less (MD = -1.14, 95% CI -1.61 to -0.67, P = 0.01). The rate of postoperative morbidity was more in the OH group, but there is no statistically significant difference between the two groups in postoperative morbidity (OR = 0.52, 95% CI 0.13-2.06, P = 0.35).
Conclusion:
Laparoscopic surgery is a feasible, safe treatment of choledochal cyst with less postoperative morbidity, a shorter length of stay and a lower blood loss when compared with open approach. With the improvement of laparoscopic techniques and deftness of surgeons practice, laparoscopic surgery may become the first choice procedure for choledochal cyst.
