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Outcomes of laparoscopic versus open resection of pediatric choledochal cyst
Walter A Ramsey1, Carlos T Huerta1, Shreya M Ingle1
1DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Insights
Laparoscopic surgery for pediatric choledochal cysts (CC) offers shorter hospital stays, lower costs, and fewer complications compared to open surgery. This approach is safe and effective for CC treatment in children.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes Research
Background:
- Untreated pediatric choledochal cysts (CC) can lead to serious complications like cholangitis, pancreatitis, and malignancy.
- Surgical excision with biliary reconstruction is the standard treatment for pediatric CC.
- Both open and laparoscopic approaches are used, but national-level outcome comparisons are limited.
Purpose of the Study:
- To compare the outcomes of open versus laparoscopic surgical approaches for pediatric choledochal cyst excision on a national level.
- To analyze differences in demographics, operative management, and complications between surgical approaches.
Main Methods:
- A retrospective comparative study using the Nationwide Readmissions Database (2016-2018).
- Identified pediatric patients (0-21 years) with choledochal cysts.
- Stratified patients by operative approach (open vs. laparoscopic) and compared outcomes using statistical tests.
Main Results:
- Laparoscopic excision was performed in 28% of 577 pediatric CC cases, while open surgery was used in 72%.
- Open surgery was associated with longer hospital stays, higher costs, and more complications.
- Anastomotic techniques differed: Roux-en-Y hepaticojejunostomy (RYHJ) with open, hepaticoduodenostomy (HD) with laparoscopic procedures (p < 0.001). No significant difference in post-operative cholangitis or mortality.
Conclusions:
- Laparoscopic choledochal cyst resection is a safe and effective alternative to open surgery in pediatric patients.
- Laparoscopic approach is linked to shorter length of stay, reduced costs, and fewer complications.
- While HD is common in laparoscopic cases and RYHJ in open cases, both have distinct short-term complication profiles.
Background:
Untreated pediatric choledochal cyst (CC) is associated with complications including cholangitis, pancreatitis, and risk of malignancy. Therefore, CC is typically treated by surgical excision with biliary reconstruction. Both open and laparoscopic (lap) surgical approaches are regularly used, but outcomes have not been compared on a national level.
Methods:
The Nationwide Readmissions Database was used to identify pediatric patients (age 0-21 years, excluding newborns) with choledochal cyst from 2016 to 2018 based on ICD-10 codes. Patients were stratified by operative approach (open vs. lap). Demographics, operative management, and complications were compared using standard statistical tests. Results were weighted for national estimates.
Results:
Choledochal cyst excision was performed in 577 children (75% female) via lap (28%) and open (72%) surgical approaches. Patients undergoing an open resection experienced longer index hospital length of stay (LOS), higher total cost, and more complications. Anastomotic technique differed by approach, with Roux-en-Y hepaticojejunostomy (RYHJ) more often utilized with open cases (86% vs. 29%) and hepaticoduodenostomy (HD) more common with laparoscopic procedures (71% vs. 15%), both p < 0.001. There was no significant difference in post-operative cholangitis or mortality.
Conclusions:
Although utilized less frequently than an open approach, laparoscopic choledochal cyst resection is safe in pediatric patients and is associated with shorter LOS, lower costs, and fewer complications. HD anastomosis is more commonly performed during laparoscopic procedures, whereas RYHJ more commonly used with the open approach. While HD is associated with more short-term gastrointestinal dysfunction than RYHJ, the latter is more commonly associated with sepsis, wound infection, and respiratory dysfunction.
Level Of Evidence:
Level III: Retrospective Comparative Study.
