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Updated: May 10, 2026
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Risk factors for bile leakage following laparoscopic cyst excision and hepaticojejunostomy in pediatric choledochal
YanBing Huang1, YuanBin He1, Wen You1
1Department of General Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Insights
Bile duct stones and prior biliary surgery are key risk factors for bile leakage after laparoscopic treatment for pediatric choledochal cysts (CDCs). Careful management of biliary inflammation and stones, along with precise surgical techniques, is crucial for preventing complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Complications
Background:
- Laparoscopic surgery is a standard treatment for pediatric choledochal cysts (CDCs).
- Bile leakage is a significant early postoperative complication following these procedures.
- Identifying risk factors is essential for improving patient outcomes.
Purpose of the Study:
- To identify risk factors for bile leakage after laparoscopic choledochal cyst excision and hepaticojejunostomy in pediatric patients.
- To optimize perioperative management strategies for preventing bile leakage.
Main Methods:
- A retrospective study of 131 pediatric patients undergoing laparoscopic cyst excision and hepaticojejunostomy.
- Data collected from electronic medical records.
- Univariate and multivariate regression analyses to determine risk factors for bile leakage.
Main Results:
- Bile duct stones (OR=4.4) and prior biliary surgery (OR=5.1) were identified as independent risk factors for bile leakage.
- Preoperative pancreatitis, cholangitis, type IV CDCs, and bile duct stones were associated with bile leakage in univariable analysis.
- 14.5% of patients experienced bile leakage, with 50% requiring reintervention.
Conclusions:
- Bile duct stones and prior biliary surgery significantly elevate the risk of bile leakage in pediatric CDCs.
- Proactive management of biliary inflammation and complete stone clearance are vital.
- Meticulous surgical techniques are critical for minimizing postoperative complications.
Purpose:
Laparoscopic surgery has been accepted as an effective and safe approach for the treatment in pediatric choledochal cysts (CDCs). However, bile leakage remains one of the most severe early postoperative complications. This study aims to identify risk factors for bile leakage following laparoscopic cyst excision and hepaticojejunostomy in pediatric CDCs and optimize perioperative management strategies.
Methods:
A retrospective study was conducted on children who underwent laparoscopic cyst excision and hepaticojejunostomy at Fujian Children's Hospital between January 2016 and January 2025. Comprehensive clinical data were extracted from institutional electronic medical records. Participants were stratified into bile leakage and non-bile leakage groups. Univariate analysis and multivariate regression models were used to identify risk factors.
Results:
A total of 131 patients were included in this study. The median age of included children was 1.8 years (range: 0.1 ~ 14.3), with a male-to-female ratio of 1.0:3.6. There were 14 cases included in the bile leakage groups, with 7 cases (50%) required surgical reintervention. Univariable analysis indicated that bile leakage was associated with preoperative pancreatitis (p = 0.02), cholangitis (p = 0.03), type IV CDCs (p = 0.03), bile duct stones (p = 0.01), and prior biliary surgery (p = 0.02). Multivariable analysis showed that bile duct stones (OR = 4.4, 95% CI 1.0 ~ 18.8) and prior biliary surgery (OR = 5.1, 95% CI 1.1 ~ 23.0) were independent factors that were associated with bile leakage.
Conclusion:
Bile duct stones and prior biliary surgery significantly increase the risk of bile leakage in pediatric CDCs following laparoscopic cyst excision and hepaticojejunostomy. Proactive management of biliary inflammation, complete stone clearance, and meticulous surgical techniques are critical for the prevention of complications.
