Laparoscopic management of choledochal cysts: is a keyhole view missing the big picture?

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Oncology

Background:

• Laparoscopic surgery for pediatric choledochal cysts is increasingly reported.
• Existing studies often lack sufficient long-term follow-up.
• Concerns exist regarding the completeness of surgical excision and reconstruction techniques used laparoscopically.

Purpose of the Study:

• To evaluate the long-term safety and efficacy of laparoscopic versus open surgery for pediatric choledochal cysts.
• To assess whether current laparoscopic techniques achieve optimal oncologic and functional outcomes.
• To emphasize the importance of radical excision and appropriate biliary reconstruction for choledochal cyst management.

Main Methods:

• Review of existing literature on laparoscopic and open surgical treatment of choledochal cysts in children.
• Analysis of reported follow-up periods and surgical techniques, particularly regarding excision extent and reconstruction method.
• Comparison of complication rates, including bilioenteric strictures and malignant transformation, between different surgical approaches.

Main Results:

• Many laparoscopic approaches do not perform radical excision of extrahepatic bile ducts with wide hepaticojejunostomy.
• Less radical excisions may increase long-term risks of strictures, complications, and malignancy in residual ducts.
• Short-term advantages of laparoscopy may overshadow critical long-term patient health considerations.

Conclusions:

• Current laparoscopic techniques for choledochal cysts may not represent the optimal surgical approach for long-term patient outcomes.
• Radical excision and reconstruction remain paramount for preventing serious long-term sequelae.
• Laparoscopic surgery should not become the standard of care without robust evidence of equivalent or superior long-term results compared to open surgery.