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Updated: Oct 9, 2025
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Laparoscopic hepaticoduodenostomy for choledochal cysts in children <1 year
Ahmed Arafa1, Moutaz Ragab1, Gamal Hassan Eltagy1
1Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt.
Insights
Laparoscopic choledochal cyst (CHC) excision and hepaticoduodenostomy are safe for infants under one year. This minimally invasive approach shows satisfactory short-term outcomes in young children with CHC.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Choledochal cyst (CHC) is a common cause of surgical jaundice in infants.
- Laparoscopic techniques for CHC excision are established in older children but less documented in infants.
- This study addresses the gap in understanding laparoscopic CHC management in the youngest patients.
Purpose of the Study:
- To evaluate the safety and short-term outcomes of laparoscopic CHC excision with hepaticoduodenostomy in infants (<1 year).
- To assess the feasibility of minimally invasive CHC treatment in a very young pediatric population.
Main Methods:
- Retrospective review of 10 consecutive infants (<1 year) undergoing laparoscopic CHC excision and hepaticoduodenostomy.
- Analysis of operative time, hospital stay, complications, and long-term outcomes.
Main Results:
- All 10 infants underwent successful total cyst excision with no need for blood transfusion.
- Mean operative time was 200 minutes, and mean hospital stay was 6 days.
- Morbidity was 20% (cholangitis episodes), with no anastomotic strictures, biliary fistulas, or mortality at 30/90 days.
Conclusions:
- Laparoscopic hepaticoduodenostomy for CHC in infants (<1 year) is a safe and effective procedure.
- The technique yields satisfactory short-term results, supporting its use in this age group.
Context:
Choledochal cyst (CHC) is one of the most common causes of surgical jaundice in infants. In 1955, Farello et al. were the first to introduce the laparoscopic approach for treatment of CHC.
Aim Of The Study:
Minimally invasive approaches to the management of CHC excision have been done in pre-schoolers and above but have not yet been described in toddlers, let alone infants. Herein, we review the results of 10 consecutive children <1 year managed with laparoscopic CHC excision and hepaticoduodenostomy.
Methods:
This retrospective study investigated 10 infants who underwent laparoscopic resection of a CHC with creation of a hepaticoduodenostomy.
Results:
This study was performed on 10 consecutive patients <1 year. Liver fibrosis was found in 4 patients. We had 7 cases with Type 1 CHCs and 3 cases with Type IV A cysts. Total cyst excision was done in all patients, no cases needed blood transfusion and the mean operative time was 200 min. The mean hospital stay was 6 days. Overall, morbidity occurred in 20% of the cases presenting with bouts of cholangitis that resolved without any intervention, once at 6 months, the other at 1-year post-operative. There were neither anastomotic strictures nor biliary fistula formation; magnetic resonance cholangiopancreatography was done to these two cases revealed no stricture and mortality at 30 and 90 days was nil.
Conclusion:
Laparoscopic hepaticoduodenostomy in CHC in children <1 year is safe, with satisfactory short-term results.
