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Updated: Sep 29, 2025
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Elective choledochal cyst excision is associated with improved postoperative outcomes in children
David N Hanna1, Katlyn G McKay2, Muhammad O Ghani1
1Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Elective surgery for pediatric choledochal cysts (CDC) leads to shorter hospital stays and less opioid use. Urgent CDC excision due to symptoms resulted in longer recovery compared to planned procedures.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Choledochal cysts (CDC) are congenital biliary tract malformations.
- Most pediatric patients present with symptoms necessitating surgical intervention.
- The optimal timing for CDC excision remains a key consideration for pediatric surgical care.
Purpose of the Study:
- To evaluate the impact of surgical timing on postoperative outcomes in pediatric patients undergoing choledochal cyst excision.
- To compare outcomes between elective CDC excision and urgent excision performed during the same admission for symptomatic presentation.
Main Methods:
- Retrospective review of 59 pediatric patients who underwent open CDC excision with Roux-Y hepaticojejunostomy (2000-2020).
- Patients were stratified into elective versus urgent surgery groups based on admission reason and timing.
- Comparison of patient demographics, perioperative data, and postoperative outcomes between the two groups.
Main Results:
- Elective CDC excision was associated with older patient age, higher prevalence of Todani-type 1 cysts, and significantly reduced postoperative hospital length of stay and opioid consumption.
- No significant differences were observed in the rates of postoperative complications between elective and urgent groups.
- Multivariable analysis confirmed that elective excision and type 1 CDC were independent predictors of decreased opioid use and shorter hospital stay.
Conclusions:
- Elective choledochal cyst excision in children is linked to improved postoperative outcomes, specifically shorter hospital stays and reduced opioid requirements.
- Urgent CDC excision, performed during the same admission for symptomatic presentation, is associated with less favorable outcomes compared to elective procedures.
- These findings support the consideration of elective surgical timing for pediatric choledochal cysts when clinically feasible.
Purpose:
The majority of pediatric patients with choledochal cysts (CDC) are symptomatic prior to undergoing CDC excision. This study investigated the impact of surgical timing of CDC excision on postoperative outcomes among children.
Methods:
We performed a retrospective review of 59 patients undergoing open CDC excision with Roux-Y hepaticojejunostomy between 2000 and 2020. Patients were grouped based on whether they underwent an electively scheduled or urgent CDC excision, as defined as CDC excision within the same admission due to CDC-related symptoms. Patient characteristics and perioperative data were compared between the two groups.
Results:
Patients who underwent an elective surgery were older, had more Todani-type 1 CDC, and had decreased postoperative hospital length of stay and opioid use compared to patients who underwent CDC excision within the same admission due to CDC-related symptoms. No significant differences emerged regarding postoperative complications. Multivariable analysis showed that elective cyst excision (HR = 0.55, p = 0.04; HR = 0.59, p = 0.008) and type 1 CDC (HR = 0.32, p = 0.03; HR = 0.12, p < 0.001) were independently associated with decreased opioid use and postoperative hospital length of stay.
Conclusions:
Elective CDC excision is associated with shortened hospital stay and decreased opioid use among children compared to patients who undergo a CDC excision during the same admission for CDC-related symptoms.
