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Choledochal Cyst in Children Under Six Months: Is Da Vinci Robot-Assisted Surgery More Advantageous?
Sai Chen1, Zhigang Gao1, Qingjiang Chen1
1Department of General Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Insights
Robot-assisted hepaticojejunostomy (RAHJ) offers faster recovery and fewer complications for infants with choledochal cysts (CDC) compared to laparoscopic-assisted hepaticojejunostomy (LAHJ). RAHJ is recommended for its superior outcomes, excluding cost considerations.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Choledochal cysts (CDC) surgery in infants under 6 months is uncommon.
- Comparing surgical approaches for CDC in this age group is crucial for optimizing outcomes.
Purpose of the Study:
- To compare the efficacy and safety of robot-assisted hepaticojejunostomy (RAHJ) versus laparoscopic-assisted hepaticojejunostomy (LAHJ) for treating choledochal cysts in children younger than 6 months.
- To evaluate key surgical outcomes including operation time, postoperative hospital stay, complications, and costs.
Main Methods:
- Retrospective study of 84 infants (<6 months) undergoing RAHJ (34 patients) or LAHJ (50 patients) for CDC.
- Data collected included operative details, postoperative recovery, complications, and hospitalization costs.
- Follow-up duration varied between RAHJ (18 months) and LAHJ (48 months) groups.
Main Results:
- RAHJ group showed a significantly longer median operation time (182 min) compared to LAHJ (168 min) (P=.02).
- RAHJ group had a significantly shorter median postoperative hospital stay (9 days) than LAHJ (11 days) (P<.001).
- RAHJ resulted in significantly higher median hospitalization costs (75,474 CNY) versus LAHJ (28,984 CNY) (P<.01), with fewer postoperative complications (e.g., no biliary fistula in RAHJ group).
Conclusions:
- Robot-assisted hepaticojejunostomy (RAHJ) demonstrates superior postoperative recovery and reduced complications in infants with choledochal cysts.
- Despite higher initial costs, RAHJ is recommended for its favorable clinical outcomes in this pediatric population.
- Further research may explore long-term outcomes and cost-effectiveness.
Abstract:
Surgery for choledochal cysts (CDC) in children younger than 6 months is relatively rare. We report our experience and compare the results between Da Vinci robot-assisted hepaticojejunostomy (RAHJ) and laparoscopic-assisted hepaticojejunostomy (LAHJ) in children younger than 6 months to treat CDC. A retrospective study was conducted on all children under 6 months of age who underwent RAHJ or LAHJ at the Children's Hospital, Zhejiang University School of Medicine, from July 2018 to November 2023. We reviewed 34 patients who underwent RAHJ surgery and 50 patients who underwent LAHJ surgery (P = .243). RAHJ group of the median operation time was 182 minutes (range 161-221), and LAHJ group was 168 minutes (range 143-191) (P = .02). The RAHJ group had a significantly shorter median postoperative hospital stay of 9 days (range 7-10) than the LAHJ group, 11 days (range 10-14), p < .001. The median hospitalization cost in the RAHJ group was significantly higher than that in the LAHJ group (75,474 CNY versus 28,984 CNY, p < .01). The median follow-up time was 18 months in the RAHJ group and 48 months in the LAHJ group (p < .01). All patients in the RAHJ group recovered well and were discharged. One patient in the LAHJ group developed biliary fistula 21 days after surgery and recovered well after reoperation. For children under 6 months old, on the basis of no consideration of cost, RAHJ has fast postoperative recovery and fewer postoperative complications, which is more recommended.
