Laparoscopic redo hepaticojejunostomy for children with choledochal cysts
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Updated: Mar 22, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Mei Diao1, Long Li2, Wei Cheng3,4,5
1Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People's Republic of China.
Insights
Laparoscopic redo hepaticojejunostomy (LRH) offers effective long-term treatment for children with biliary re-obstructions from choledochal cysts (CDCs). This minimally invasive approach shows comparable or superior outcomes to open surgery, with reduced recovery times and complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Choledochal cysts (CDCs) can lead to biliary re-obstructions after initial treatment.
- Redo surgery is sometimes necessary to address these complications.
- Laparoscopic redo hepaticojejunostomy (LRH) is a potential minimally invasive option.
Purpose of the Study:
- To evaluate the long-term efficacy of laparoscopic redo hepaticojejunostomy (LRH) in pediatric patients with choledochal cysts (CDCs).
- To compare the outcomes of LRH with open redo hepaticojejunostomy (ORH).
Main Methods:
- A retrospective comparison of 44 children undergoing LRH (2006-2016) versus 16 children undergoing ORH (2001-2005).
- Key surgical techniques included repositioning hepatic arteries and performing wide hepaticojejunostomies.
- Outcomes assessed included operative time, recovery, complications, and long-term patency.
Main Results:
- LRH demonstrated significantly shorter postoperative hospital stays, earlier resumption of diet, and shorter drainage duration compared to ORH.
- No significant differences in operative time were observed between LRH and ORH.
- Overall morbidity was significantly lower in the LRH group (2.3%) compared to the ORH group (18.8%), with no recurrent biliary obstructions, cholangitis, or carcinoma in either group during follow-up.
Conclusions:
- Laparoscopic redo hepaticojejunostomy (LRH) is a viable and effective alternative to open surgery for managing biliary re-obstructions in children with choledochal cysts.
- LRH offers comparable or superior long-term results with improved postoperative recovery and reduced morbidity.
- This approach can be safely performed by experienced surgeons, potentially avoiding the need for open procedures.
Background:
The current study is to evaluate the long-term efficacy of laparoscopic redo hepaticojejunostomy (LRH) for children with cholecochal cysts (CDCs).
Methods:
Between January 2006 and January 2016, 44 CDC children who had biliary re-obstructions after primary definitive surgeries successfully underwent LRH in our hospital. The hepatic arteries were repositioned behind Roux loop. Ductoplasties and wide hepaticojejunostomies were carried out. The operative time, postoperative recovery and complications were compared with our open redo hepaticojejunostomy (ORH, n = 16) between October 2001 and December 2005.
Results:
There was no significant difference of age at surgery between two groups. Mean operative time in the LRH group was 2.32 h, which did not differ from 2.05 h in the ORH group (p = 0.11). Average postoperative hospital stay, resumption of full diet and duration of drainage in the LRH group were 5.47, 2.11 and 3.22 days, respectively, significantly shorter than 7.37, 3.31 and 4.50 days in our ORH group (p < 0.001, respectively). Median follow-up period was 48 months (1-120 months) in the LRH group and 140 months (120-170 months) in the ORH group. No recurrent biliary obstruction, cholangitis, intrahepatic stone formation or carcinoma were detected in either group. No blood transfusion was required in the LRH group, while one patient in ORH group required 3-day hemostatic treatment and blood transfusion for postoperative bleeding. In the LRH group, one patient suffered from bile leak and spontaneously cured after 7-day drainage. Two patients in the ORH group developed wound dehiscence and required surgical repairs. Overall morbidities were 2.3 % (1/44) in LRH group and significantly <18.8 % (3/16) in ORH group (p < 0.05). Liver function parameters normalized in both groups.
Conclusions:
In experienced hands, LRH does not necessarily require open surgery. Long-term results of the LRH group were comparable or even superior to those of the ORH group.
