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Updated: Oct 25, 2025
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
[Comparative analysis of the bile duct reconstruction methods in children with choledochal malformation]
A Yu Razumovskiy1,2, Z B Mitupov1,2, N V Kulikova1,2
1Pirogov Russian National Research Medical University, Moscow, Russia.
Insights
Mini-laparotomy with Roux-en-Y hepaticojejunostomy offers advantages for bile duct reconstruction in children with choledochal malformation, showing faster recovery and better long-term outcomes compared to other surgical methods.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Choledochal malformation (CM) necessitates surgical intervention for bile duct reconstruction in children.
- Various surgical approaches, including mini-laparotomy (ML), laparoscopy (LS), and laparotomy (LT), have been employed.
Purpose of the Study:
- To compare the efficacy and outcomes of different bile duct reconstruction methods in pediatric CM patients.
- To evaluate surgical time, and short-term and long-term postoperative results.
Main Methods:
- A retrospective analysis of 99 children with CM over a 10-year period.
- Surgical procedures included radical CM resection with Roux-en-Y hepaticojejunostomy (RYHJ) or hepaticoduodenostomy (HD) via ML, LS, or LT.
- Outcomes assessed included operative time, hospital stay, recovery speed, and complication rates.
Main Results:
- Mini-laparotomy with Roux-en-Y hepaticojejunostomy (ML RYHJ) demonstrated faster intestinal recovery and shorter postoperative narcotic anesthesia duration compared to laparoscopy (LS) RYHJ and hepaticoduodenostomy (HD).
- Laparoscopic RYHJ, particularly intracorporeal, showed a shorter hospital stay but required longer operative time.
- Hepaticoduodenostomy (HD) was associated with a higher incidence of severe postoperative pancreatitis requiring surgical correction.
Conclusions:
- Mini-laparotomy Roux-en-Y hepaticojejunostomy (ML RYHJ) presents advantages over other surgical techniques for bile duct reconstruction in pediatric choledochal malformation.
- ML RYHJ is recommended as a preferable method due to its favorable short-term and long-term outcomes.
Objective:
To compare various methods of bile duct reconstruction in children with choledochal malformation (CM).
Material And Methods:
There were 99 children with CM over 10-year period. Mini-laparotomy (ML), laparoscopy (LS) and laparotomy (LT) were used. We performed radical CM resection and bile duct reconstruction using Roux-en-Y hepaticojejunostomy (RYHJ) and hepaticoduodenostomy (HD). Surgery time, short-term and long-term postoperative outcomes were evaluated.
Results:
ML was performed in 39 patients, LS - 51 patients, LT - 9 patients. In case of LS, hospital-stay was significantly lower after intracorporeal RYHJ formation compared to extracorporeal technique (p=0.02, Mann-Whitney U-test). Intracorporeal RYHJ requires more time (p=0.0003). Intestinal passage recovered 3 times faster in the ML RYHJ group compared to the LS RYHJ group (p=0.016, Mann-Whitney U-test). ML RYHJ was followed by significantly less duration of postoperative narcotic anesthesia compared to LS HD (3 vs. 4 days, p=0.02, Mann-Whitney U-test). In our study, ML RYHJ has an advantage over LS RYHJ regarding long-term outcomes. HD resulted higher incidence of severe postoperative pancreatitis (p=0.033) that required surgical correction (LT, p=0.043).
Conclusion:
ML RYHJ has some advantages over other methods of bile duct reconstruction. Therefore, we can currently recommend this method as a preferable one.
