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Evaluating surgical strategies for pediatric congenital choledochal cysts: a multicenter retrospective study and

Chuang Cao1, Zhibin Xu2, Long Cen3

  • 1Department of Pediatric Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.

Frontiers in Pediatrics
|October 13, 2025
PubMed

Insights

This network meta-analysis compared open, laparoscopic, and robotic surgeries for pediatric congenital choledochal cysts (CCC). Robotic surgery reduced hospital stay and bile leakage, while laparoscopic surgery minimized blood loss and bowel obstruction.

Area of Science:

  • Pediatric Surgery
  • Surgical Innovation
  • Gastrointestinal Surgery

Background:

  • Congenital choledochal cysts (CCC) are rare biliary tract malformations requiring surgical intervention.
  • Choosing the optimal surgical approach for pediatric CCC remains a clinical challenge.
  • Efficacy and safety data for open, laparoscopic, and robotic-assisted surgeries are often fragmented.

Purpose of the Study:

  • To compare the efficacy and safety of open, laparoscopic, and robotic-assisted surgeries for pediatric congenital choledochal cysts (CCC).
  • To provide evidence-based guidance for surgical decision-making in pediatric CCC management.
  • To validate network meta-analysis findings with retrospective cohort data.

Main Methods:

  • A systematic literature search adhering to PRISMA guidelines identified 28 cohort studies (3,672 patients).
  • Network meta-analysis using a Bayesian model assessed operative time, hospital stay, blood loss, bile leakage, and bowel obstruction.
  • Retrospective data from 72 CCC patients (open vs. laparoscopic surgery) were incorporated for consistency validation.

Main Results:

  • Open surgery demonstrated the shortest operative time, while robotic-assisted surgery offered the shortest hospital stay.
  • Laparoscopic surgery resulted in the least blood loss and lowest bowel obstruction rates.
  • Robotic-assisted surgery showed the lowest bile leakage rate; retrospective data confirmed operative time and blood loss differences.

Conclusions:

  • Robotic-assisted surgery is associated with reduced hospital stay and bile leakage.
  • Laparoscopic surgery is advantageous for minimizing blood loss and bowel obstruction.
  • Open surgery is quickest but less favorable for other outcomes, highlighting the need for randomized trials to refine surgical choices.
Abstract

Keywords:
Bayesian modelcongenital choledochal cystlaparoscopic surgerynetwork meta-analysispediatric surgical outcomesrobotic-assisted surgery

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