Consensus Statements on Minimally Invasive Surgery for Congenital Biliary Dilatation

Minimally invasive surgery for congenital biliary dilatation (MICBD), including both laparoscopic and robotic approaches, is gaining increasing popularity. However, the evidence remains limited, especially across both adult and pediatric populations.

Consensus statements on MICBD were formulated during a multidisciplinary consensus meeting, addressing two clinical questions focused on the use of MICBD in Todani classification types I and IV-A. A comprehensive literature review and expert survey were performed. Consensus was achieved through a Delphi voting process, with statements approved when ≥ 75% agreement was reached.

The literature review revealed that although MICBD was associated with prolonged operative times, the approach resulted in reduced blood loss and shorter hospital stays, with complication rates comparable to those observed in open surgery. In the expert survey, MICBD was supported by 81% of respondents for type I and 64% for type IV-A. The following consensus statement was developed: "MICBD for both Todani classification type I and type IV-A can be considered; however, it is preferable for the procedure to be performed by a team experience in minimally invasive surgery." This statement achieved unanimous agreement in the Delphi vote.

Due to a lack of high-level evidence, formal recommendations for MICBD remain premature. Expert consensus supports MICBD for both types I and IV-A cases, provided that the procedures are performed by experienced surgical teams. Further high-quality studies and long-term outcome assessments are essential to establish safety and efficacy.