Totally laparoscopic surgery for choledochal cysts with hand‑sewn Roux‑en‑Y reconstruction in a pediatric population

Area of Science:

• Pediatric Surgery
• Gastrointestinal Surgery
• Minimally Invasive Surgery

Background:

• Choledochal cysts (CCs) are congenital bile duct anomalies requiring surgical intervention.
• Roux-en-Y hepaticojejunostomy (RYHJ) following cyst excision is the standard surgical approach for CCs.
• Minimally invasive techniques are increasingly explored for pediatric surgical conditions.

Purpose of the Study:

• To evaluate the safety and efficacy of totally laparoscopic surgery for choledochal cysts (TLCCs) in a pediatric population.
• To assess postoperative recovery and complication rates associated with TLCCs.
• To compare TLCCs with conventional laparoscopic surgery for CCs in terms of patient outcomes.

Main Methods:

• Retrospective review of clinical data from 28 pediatric patients with CCs who underwent TLCCs between June 2020 and June 2023.
• All procedures involved cyst excision and RYHJ with laparoscopically completed jejunojejunal anastomosis using manual sutures.
• Data collected included age, operative time, postoperative recovery (time to oral diet), and complications.

Main Results:

• Twenty-eight pediatric patients (8 boys, 20 girls) underwent TLCCs at a mean age of 4.2 years.
• Mean operative time was 214 minutes, with a mean time to oral diet of 2.89 days.
• The main complications were bile leakage and wound infection; no other significant issues arose during a median 18-month follow-up.

Conclusions:

• Totally laparoscopic choledochal cyst excision and RYHJ (TLCCs) can be safely performed in pediatric patients by experienced surgeons.
• TLCCs demonstrate potential for enhanced physiological compatibility, accelerated intestinal function recovery, reduced trauma, and improved esthetic results.
• TLCCs utilizing manual sutures represent a viable minimally invasive surgical option for pediatric choledochal cysts.