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Updated: Mar 27, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Transition of Techniques to Treat Choledochal Cysts in Children
Brian G A Dalton1, Katherine W Gonzalez1, Jeffrey J Dehmer1
1Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
Insights
Laparoscopic surgery for choledochal cysts, using hepaticojejunostomy (HJ) or hepaticoduodenostomy (HD) reconstruction, is as safe and effective as open surgery.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Gastrointestinal Surgery
Background:
- Choledochal cysts traditionally treated with open resection and hepaticojejunostomy (HJ).
- Center transitioned to laparoscopic excision with HJ or hepaticoduodenostomy (HD) reconstruction.
- Initial experience with this minimally invasive approach is presented.
Purpose of the Study:
- Evaluate the safety and efficacy of laparoscopic choledochal cyst resection.
- Compare outcomes of laparoscopic versus open surgery.
- Compare outcomes of hepaticoduodenostomy (HD) versus hepaticojejunostomy (HJ) reconstruction.
Main Methods:
- Single-center retrospective chart review (2005-2014).
- Included all patients undergoing surgical treatment for choledochal disease.
- Compared laparoscopic and open approaches, and HD vs. HJ reconstructions.
Main Results:
- 18 patients treated; 11 underwent laparoscopic surgery.
- No significant differences in operative time, blood loss, diet, length of stay, or complications.
- Mean follow-up of 3.1 years showed no bile reflux or cholangitis.
Conclusions:
- Laparoscopic choledochal cyst resection with HJ or HD reconstruction is safe.
- Outcomes are equivalent to traditional open procedures.
- Laparoscopic approach offers a viable alternative for choledochal cyst treatment.
Introduction:
Traditionally open resection with hepaticojejunostomy (HJ) reconstruction has been the surgical treatment for cases of choledochal cyst. Our center has recently transitioned from open to laparoscopic and HJ to hepaticoduodenostomy (HD) as our preferred method of excision and biliary reconstruction. Our initial experience is presented here.
Materials And Methods:
A single-center retrospective chart review was performed from 2005 to 2014. All patients undergoing surgical treatment for choledochal disease were considered.
Results:
During the study period 18 patients had surgical treatment for choledochal cyst disease. The average age of all patients was 4.7 years (range, 2 months-15.5 years). Eleven of these patients had laparoscopic excision and reconstruction. Of these 11 patients, 7 had an HD anastomosis. Comparing the laparoscopic with the open group and the HD with the HJ group, there was no significant difference in operative time, estimated blood loss, time to regular diet, length of stay, or complication rate. Mean follow-up of 3.1 years revealed no documented cases of bile reflux or cholangitis. A recent adaptation in technique may improve ease of HD anastomosis. In this method, two strands of temporary monofilament suture cut to 8-10 cm each are tied extracorporeally. This knot is then placed on the outside of the medial corner. The anastomosis is then completed in a running fashion with the two strands and then secured intracorporeally at the lateral corner.
Conclusions:
Laparoscopic choledochal cyst resection with both HJ and HD reconstruction appears safe and has equivalent outcomes to open procedures in our series.
