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Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Risk factors for complications after laparoscopic surgery in children with congenital choledochal cysts
Jie Li1, Bingyu Zhang1, Jinfeng Li1
1Department of Pediatric Surgery, Leshan Women and Children Hospital, Leshan, China.
Insights
Postoperative complications after laparoscopic surgery for pediatric choledochal cysts (CCCs) can be predicted by cyst wall thickness, chronic cholecystitis, Todani type I, elevated CRP, and direct bilirubin. These factors aid in risk assessment and clinical management.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Laparoscopic Roux-en-Y hepaticojejunostomy is standard for pediatric congenital choledochal cysts (CCCs).
- Postoperative complications present a significant clinical challenge.
- Identifying risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To identify independent risk factors for complications after laparoscopic CCC excision in children.
- To develop a predictive model for stratifying complication risk.
Main Methods:
- Retrospective cohort study of 362 pediatric patients undergoing laparoscopic CCC surgery.
- Systematic collection of preoperative variables.
- Univariable/multivariable logistic regression and Cox regression analyses for predictor identification and risk stratification.
Main Results:
- Complications occurred in 9.39% of patients, most commonly anastomotic stricture, choledocholithiasis, and pancreatitis.
- Independent predictors identified: cyst wall thickness >5 mm, chronic cholecystitis, Todani type I, elevated C-reactive protein (CRP), and elevated direct bilirubin (DB).
- Cyst wall thickness, chronic cholecystitis, Todani type I, and CRP predicted overall complications; DB was linked to choledocholithiasis.
Conclusions:
- Cyst wall thickness >5 mm, chronic cholecystitis, Todani Type I, elevated CRP, and elevated DB are key prognostic factors for pediatric CCCs.
- These factors provide valuable reference for prognostic evaluation and clinical management.
- The findings support targeted interventions and closer monitoring for high-risk patients.
Background:
Laparoscopic Roux‑en‑Y hepaticojejunostomy is the standard treatment for pediatric congenital choledochal cysts (CCCs). However, postoperative complications remain a significant clinical challenge. This study aimed to identify independent risk factors and develop a predictive model for complications following laparoscopic CCC excision in children.
Methods:
We conducted a retrospective cohort study of 362 pediatric patients who underwent laparoscopic surgery for CCC between August 2019 and July 2024 at two tertiary centers. Preoperative variables were systematically collected. Univariable and multivariable logistic regression analyses identified predictors of complications, with significant variables (P<0.05) incorporated into a nomogram for risk stratification. Subgroup and Cox regression analyses were used to evaluate factors for specific complications and time-to-event outcomes.
Results:
Postoperative complications occurred in 34 patients (9.39%). The most common were biliary-intestinal anastomotic stricture (35.3%), choledocholithiasis (23.5%), and pancreatitis (20.6%). Independent predictors included: cyst wall thickness >5 mm [odds ratio (OR) =4.23, 95% confidence interval (CI): 1.26-6.75; P<0.001], chronic cholecystitis (OR =6.42, 95% CI: 3.39-9.24; P<0.001), Todani type I (OR =6.13, 95% CI: 2.74-10.38; P=0.002), elevated C-reactive protein (CRP) (OR =1.52, 95% CI: 1.12-2.16; P=0.04), and elevated direct bilirubin (DB; OR =2.05, 95% CI: 1.23-4.17; P=0.04). Subgroup analysis confirmed cyst wall thickness, chronic cholecystitis, Todani type I, and CRP consistently predicted all complications, while DB was specifically linked to choledocholithiasis (P=0.02). Cox regression further associated cyst wall thickness >5 mm with higher complication risk (P=0.04).
Conclusions:
Cyst wall thickness >5 mm, chronic cholecystitis, Todani Type I, elevated CRP, and elevated DB were selected as factors to assess the prognosis of children with choledochal cysts, providing important reference value for the prognostic evaluation and clinical management of children with choledochal cysts.
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