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Updated: Mar 3, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Comparative clinical study of laparoscopic and open surgery in children with choledochal cysts
Guoxin Song1, Xiangyu Jiang, Jian Wang
1Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China. E-mail. sgxx2005@126.com.
Insights
Laparoscopic surgery for choledochal cysts is safe and effective in young children, offering benefits like reduced blood loss and faster recovery compared to open surgery. This minimally invasive approach shows promise for wider adoption in pediatric care.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Choledochal cysts are congenital dilations of the biliary tree, posing risks of malignancy, pancreatitis, and cholangitis.
- Surgical management, typically cyst excision and hepaticojejunostomy, has traditionally been performed via open laparotomy.
- The feasibility and outcomes of laparoscopic approaches in early childhood require further investigation.
Purpose of the Study:
- To compare the safety and effectiveness of laparoscopic surgery versus open surgery for choledochal cysts in pediatric patients.
- To evaluate the impact of patient age (specifically <3 years vs. >3 years) on outcomes for laparoscopic management.
Main Methods:
- Retrospective analysis of 206 pediatric patients with choledochal cysts (2003-2015).
- 104 patients underwent open cyst excision and hepaticojejunostomy (OP); 102 underwent laparoscopic surgery (LP).
- Comparison of perioperative and follow-up data, including age stratification for the LP group.
Main Results:
- No mortality observed in either group; all patients achieved cure.
- Laparoscopic surgery (LP) had significantly longer operating times but significantly less blood loss than open surgery (OP).
- LP demonstrated shorter time to oral feeding and reduced postoperative hospital stay compared to OP, with no significant age-related differences.
Conclusions:
- Laparoscopic management of choledochal cysts is a safe and effective option, even in very young children.
- Advantages of the laparoscopic approach include reduced blood loss, minimal trauma, quicker recovery, and improved cosmetic outcomes.
- Widespread adoption of laparoscopic surgery for pediatric choledochal cysts is recommended due to its favorable results.
Objectives:
To investigate the safety and effectiveness of laparoscopic management of choledochal cysts compared with the open approach, even in early childhood. Methods: We conducted a retrospective study of 206 patients with choledochal cysts between June 2003 and May 2015. Of these, 104 patients underwent open cyst excision and hepaticojejunostomy (open operation [OP]) and 102 patients received laparoscopic management and hepaticojejunostomy (laparoscopic operation [LP]). The patients who underwent a laparoscopic approach were further divided by the age of 3 years. We compared patients' perioperative and follow-up conditions between the 2 approaches and the 2 age groups. Results: All patients were cured with no incidence of mortality. The operating time was significantly longer in the LP (OP: 225.4±51.0 min versus LP: 170.3±35.4 min, p=0.000), but blood loss (LP: 12.9±22.9 ml versus OP: 32.4±52.7 ml, p=0.001) was significantly larger in the OP. The number of days to normal oral feeding (LP: 3.3±0.9 dyas versus OP: 4.1±0.9 days, p=0.000) and postoperative stay-in-ward duration (LP: 7.5±2.7 days versus OP: 9.6±5.5 days, p=0.001) were significantly shorter with the LP. There were no significant differences among all of the above tests between the younger and older patients (p greater than 0.05). Conclusions: Laparoscopic operation is safe and effective, even for young children. With the advantages of less blood loss, smaller trauma, shorter postoperative recovery time, and improved cosmetic features, it is worth considering its widespread application.
