Navigating the Giant: A Case Series of Giant Choledochal Cysts in Infants Managed Laparoscopically

The incidence of giant choledochal cysts (CDCs) in infants is the rarest of rare, and poses unique surgical challenges due to limited working space and close proximity to vital hepatobiliary structures. With advancements in minimally invasive surgery, laparoscopic excision has become the preferred approach. We present a case series of four infants diagnosed with giant CDCs who underwent laparoscopic cyst excision with biliary reconstruction at our institution. All four patients presented with progressively increasing abdominal distension and were diagnosed using ultrasonography followed by magnetic resonance cholangiopancreaticography. The cyst sizes ranged from 8 cm to 18 cm. Laparoscopic cyst excision with hepaticoduodenostomy was successfully performed in all patients. Technical modifications such as percutaneous cyst decompression and traction using stay sutures were utilized to facilitate safe dissection. The mean operative time was 222.5 (182-273) minutes; mean hospital stay was 8.5 (7-12) days. The follow-up period ranged from three to 16 months. Postoperative recovery was uneventful in three patients. This series demonstrates the feasibility and safety of minimally invasive surgery for giant CDCs in infants when performed with appropriate technical modifications.