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Updated: Sep 13, 2025
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Laparoscopic Excision of Choledochal Cysts with Roux-en-Y Hepaticojejunostomy in Children: Surgical Technique,
Ankur Mandelia1, Anju Verma1, Rohit Kapoor1
1Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
Laparoscopic excision of choledochal cysts (CDCs) with Roux-en-Y hepaticojejunostomy (HJ) is a safe and effective treatment for pediatric patients. This minimally invasive approach offers benefits with manageable risks, showing promise for wider adoption in pediatric surgery.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Choledochal cysts (CDCs) are congenital dilatations of the bile ducts.
- Surgical excision is the primary treatment for CDCs.
- Minimally invasive techniques are increasingly explored for pediatric surgical procedures.
Purpose of the Study:
- To evaluate the feasibility, safety, and efficacy of laparoscopic choledochal cyst excision with Roux-en-Y hepaticojejunostomy (HJ) in children.
- To assess outcomes and complications associated with this minimally invasive approach.
Main Methods:
- Retrospective review of 43 pediatric patients who underwent laparoscopic CDC excision with Roux-en-Y HJ.
- Data collected included demographics, clinical presentation, surgical details, complications, and follow-up outcomes.
- Laparoscopic HJ performed using a four-port technique with extracorporeal jejunojejunostomy.
Main Results:
- Mean age 5.5 years; 7 infants included.
- Mean operative time 406 minutes; 11.6% conversion to open surgery.
- 34.8% experienced minor postoperative complications (e.g., bile leak); 2 major complications (obstruction, stricture) required reoperation.
- Mean follow-up 27.2 months showed no recurrence of cholangitis or pancreatitis; normal liver function in most patients.
Conclusions:
- Laparoscopic CDC excision with Roux-en-Y HJ is a safe, feasible, and effective procedure in pediatric patients.
- The approach offers significant benefits with manageable risks and complications.
- Advancements in minimally invasive surgery suggest this technique may become a standard in pediatric surgical practice.
Aims:
This study aimed to evaluate the feasibility, safety, and efficacy of laparoscopic excision of choledochal cysts (CDCs) with Roux-en-Y hepaticojejunostomy (HJ) in pediatric patients at a tertiary care teaching institution in India.
Methods:
We conducted a retrospective review of electronic medical records from November 2019 to November 2024, involving 43 children who underwent laparoscopic CDC excision with Roux-en-Y HJ in a single surgical unit. Data collected included demographic information, clinical presentation, imaging features, CDC classification, preoperative interventions, surgical details, postoperative complications, and follow-up outcomes. Laparoscopic HJ was performed by a single surgeon with a four-port technique with extracorporeal jejunojejunostomy.
Results:
The cohort consisted of 43 children (26 girls), with a mean age of 5.5 (0.33-17) years and a mean weight of 16.5 (6-48) kg, including seven infants. Preoperative interventions were required in 11 (25.6%) children. The mean operative time was 406 (315-545) min, with an 11.6% conversion rate to open surgery due to difficult anatomy. Postoperative complications were observed in 34.8% of patients, primarily minor (Clavien-Dindo Grade I or II), including bile leak in 6.9% of patients, managed without further intervention. Major complications included adhesive obstruction and anastomotic stricture, requiring reoperations in two patients. The mean time to full enteral feeds was 6.5 (4-9.5) days, and the mean hospital stay was 9.3 (5-25) days. Follow-up (mean duration: 27.2 months) showed no intrahepatic biliary radical dilation or recurrent cholangitis or pancreatitis, with normal liver function tests in all patients except one who developed liver decompensation and was lost to follow-up.
Conclusions:
Laparoscopic excision of CDC with Roux-en-Y HJ in children is a safe, feasible, and effective approach, offering numerous benefits while presenting manageable risks and complications. With advancements in minimally invasive techniques and increased surgeon expertise, this method holds promise for becoming a widely adopted standard in pediatric surgery.
