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Updated: May 3, 2026
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Development and validation of a predictive model for bile leakage after choledochal cyst excision in children: A
Xin Ding1, Kai Gao2, Xinyuan Chen1
1General Surgery Department, Capital Institute of Pediatrics, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Insights
A new nomogram helps predict bile leakage after pediatric choledochal cyst surgery. This tool aids clinicians in early risk identification for better patient outcomes.
Area of Science:
- Pediatric Surgery
- Surgical Complications
- Predictive Modeling
Background:
- Bile leakage is a frequent complication following pediatric choledochal cyst surgery.
- Early detection and prevention are vital for improving patient outcomes.
Purpose of the Study:
- To develop and validate a nomogram for the early prediction of postoperative bile leakage in pediatric patients undergoing choledochal cyst surgery.
Main Methods:
- Retrospective study of 1,700 pediatric patients from two Chinese centers (2012-2023).
- LASSO regression identified independent predictors; a multivariable logistic regression model constructed the nomogram.
- External validation performed on a separate cohort of 1,014 patients.
Main Results:
- Postoperative bile leakage incidence was 1.8% (development) and 3.3% (external validation).
- Independent predictors included perioperative biliary infection, preoperative white blood cell count, anastomotic diameter, and patient age.
- The nomogram demonstrated strong discriminatory ability (AUCs 0.82-0.85) and good clinical applicability.
Conclusions:
- A nomogram utilizing perioperative clinical factors accurately predicts postoperative bile leakage in pediatric choledochal cyst surgery.
- This tool facilitates early risk stratification and timely management of potential complications.
Objective:
Bile leakage is one of the most common complications after choledochal cyst surgery in children. Early detection and prevention of this complication are crucial for improving outcomes. This study aimed to develop and validate a nomogram for early prediction of postoperative bile leakage in pediatric patients.
Methods:
This retrospective study included children who underwent choledochal cyst surgery at two tertiary pediatric centers in China between 2012 and 2023. The development cohort (n = 1,700) from the Capital Institute of Pediatrics was randomly divided into training and internal validation sets at a 7:3 ratio. Independent predictors were selected using LASSO regression, and a multivariable logistic regression model was established to construct a predictive nomogram. External validation was performed using an independent cohort (n = 1,014) from the Children's Hospital of Chongqing Medical University. Model performance was evaluated for discrimination, calibration, and clinical utility.
Results:
Postoperative bile leakage occurred in 1.8 % of patients in the development cohort and 3.3 % in the external validation cohort. LASSO regression identified perioperative biliary infection, preoperative white blood cell count, anastomotic diameter, and patient age as independent predictors of bile leakage. The final model demonstrated strong discriminatory ability, with AUCs of 0.83 (95 % CI: 0.65-1.00) in the training set, 0.85 (95 % CI: 0.78-0.91) in the internal validation set, and 0.82 (95 % CI: 0.74-0.91) in the external validation set. The calibration and decision curve analysis (DCA) curves showed good discrimination ability and clinical applicability.
Conclusions:
A nomogram based on perioperative clinical factors was developed to predict postoperative bile leakage in children undergoing choledochal cyst surgery. It provides clinicians with an accurate and practical tool for early risk identification and timely management of postoperative complications.
