Comparison of Postoperative Outcomes of Open, Laparoscopic, and Robotic Surgery for Pediatric Choledochal Cyst Excision

Choledochal cyst is treated with extrahepatic bile duct resection and hepaticojejunostomy. Minimally invasive approaches, including laparoscopic surgery (LS) and robotic surgery (RS), offer potential advantages over open surgery (OS), but their impact on perioperative and short-term postoperative outcomes remains unclear.

This retrospective study analyzed 201 pediatric patients who underwent OS (n = 83), LS (n = 89), or RS (n = 29). OS was performed from 2004 to 2013, LS from 2013, and RS from 2021. Perioperative outcomes and early postoperative complications within one year were analyzed.

RS resulted in significantly lower blood loss (median 1.6 [IQR 0.86-2.71] mL/kg) than OS (7.0 [IQR 3.88-9.70] mL/kg) (p < 0.05). Time to oral intake was shortest in RS (median 3 [IQR 3-4] days) compared with LS and OS (both 4 [IQR 4-5] days) (p < 0.05). Drain removal occurred earlier in RS (median 5 [IQR 5-6] days) than in LS (6 [IQR 6-8] days) and OS (6 [IQR 6-7] days) (p < 0.05). Hospital stay was shorter with RS (median 7 [IQR 7-9] days) than with LS (10 [IQR 8-13] days) or OS (11 [IQR 10-14] days) (p < 0.05). Operative time was shorter for OS (median 273 [IQR 240-321] min) than LS (396 [IQR 334-453] min) or RS (388 [IQR 345-530] min) (p < 0.05). Median follow-up was 1 year (range, 1-3) for RS, 6 years (1-11) for LS, and 15 years (11-20) for OS. No significant differences were found in hepatolithiasis, anastomotic stricture, or cholangitis within the first postoperative year.

RS demonstrated superior short-term outcomes, including reduced blood loss, faster recovery, and shorter hospitalization, suggesting lower invasiveness. Further studies with larger cohorts and extended follow-up are needed to evaluate long-term prognosis.

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