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Updated: Sep 11, 2025
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Open versus minimally invasive surgery for pediatric choledochal cyst in a propensity score matched cohort
Paulo Castro1, Anna M Lin2, Lindsey Asti2
1Department of Surgery, UConn Health, Farmington, CT, United States.
Insights
Minimally invasive surgery (MIS) for choledochal cysts takes longer and has more surgical site infections (SSI), but shows no difference in overall outcomes compared to open surgery. MIS use is increasing in pediatric surgery.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Minimally Invasive Surgery
Background:
- Choledochal cysts are congenital bile duct abnormalities requiring surgical intervention.
- Open surgery has been the traditional approach, but minimally invasive surgery (MIS) is gaining traction.
- Evaluating 30-day outcomes of open versus MIS for choledochal cysts is crucial for surgical decision-making.
Purpose of the Study:
- To compare 30-day postoperative outcomes between open and minimally invasive surgery (MIS) for pediatric choledochal cysts.
- To assess the trends in utilization of MIS for this condition.
- To identify potential differences in operative time, complications, and recovery between the two surgical approaches.
Main Methods:
- A retrospective comparative study using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2013-2023).
- A propensity score matched cohort of 247 children per group (open vs. MIS) was created.
- Intention-to-treat analysis was employed to compare outcomes, including operative time, surgical site infections (SSI), morbidity, length of stay, readmission, and reoperation.
Main Results:
- The minimally invasive surgery (MIS) approach was associated with a longer operative time (311 min vs. 261 min) and a higher incidence of surgical site infections (SSI) (6.5% vs. 1.6%).
- No significant differences were observed in composite morbidity, postoperative length of stay, readmission, or reoperation at 30 days between the open and MIS groups.
- Minimally invasive surgery (MIS) utilization increased significantly over the study period (p < 0.001).
Conclusions:
- While minimally invasive surgery (MIS) for pediatric choledochal cysts is increasingly utilized, it is associated with longer operative times and a higher risk of surgical site infections (SSI).
- There are no significant differences in major postoperative outcomes such as morbidity, length of stay, readmission, or reoperation at 30 days.
- Further multicenter prospective trials are warranted to definitively compare the long-term efficacy and safety of open versus MIS approaches for choledochal cysts.
Background:
This study aims to evaluate 30-day outcomes for children undergoing open versus minimally invasive surgery (MIS) for choledochal cysts using a propensity score matched cohort created from a national database.
Methods:
Children undergoing surgery for choledochal cyst from 2013 to 2023 were identified using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. A propensity score match was performed. Outcomes were compared between operative approaches using an intention-to-treat analysis. Pearson's chi-square, Fisher's exact, and Mann-Whitney's U tests were used as appropriate. A Cochran-Armitage test was used to assess operative trends.
Results:
A total of 773 children who underwent surgery for choledochal cyst were identified. Pre-match, children undergoing open surgery were more likely to be younger, smaller in weight, have Roux-en-Y hepaticojejunostomy performed, have a history of gastrointestinal disease, and have higher American Society of Anesthesiology (ASA) class. Post-match, the groups were similar and included 247 cases per group. The MIS approach was associated with a longer median operative time (311 min vs. 261 mins, p < 0.001) and more surgical site infections (SSI) (6.5 % vs. 1.6 %, p = 0.006). There were no differences in composite morbidity, postoperative length of stay, and readmission or reoperation at 30 days. MIS utilization increased over the study period (p < 0.001).
Conclusions:
MIS utilization has steadily increased within the NSQIP-P cohort. The MIS approach takes longer to perform and may be associated with a higher rate of SSIs. We observed no significant differences in overall morbidity, postoperative length of stay, readmission, or reoperation. Multicenter prospective trials would be useful to further compare these two approaches.
Type Of Study:
Retrospective comparative study.
Level Of Evidence:
Level III.
