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Updated: Aug 11, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Outcomes of laparoscopic versus open excision of choledochal cyst in preschool-aged children: analysis from a
Maria Grazia Sacco Casamassima1,2, Nadeen Alturki3, Janelle R Noel-MacDonnell4,5
1Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas, MO, 64108, USA. msaccocasamassim@cmh.edu.
Insights
Laparoscopic surgery (LS) for choledochal cysts (CC) in young children shows similar short-term complications to open surgery (OS). LS offers faster recovery and less resource use, making it a viable option with careful patient selection.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Choledochal cysts (CC) present unique surgical challenges in young children.
- Comparative outcomes between laparoscopic surgery (LS) and open surgery (OS) for CC in this age group are not well-defined.
Purpose of the Study:
- To compare the perioperative and short-term outcomes of laparoscopic surgery (LS) versus open surgery (OS) for definitive treatment of choledochal cysts in children aged 5 years or younger.
Main Methods:
- A retrospective cohort study utilized the Pediatric Health Information System (PHIS) database.
- Identified 533 children with CC undergoing definitive surgical excision between 2015 and 2025.
- Compared demographic data, operative approaches (LS vs. OS), and postoperative outcomes.
Main Results:
- No significant difference in 90-day postoperative complications between LS and OS.
- LS was associated with fewer blood transfusions, reduced need for total parenteral nutrition and mechanical ventilation, and decreased intensive care unit admissions.
- LS resulted in a shorter length of hospital stay, though biliary calculi were more frequent post-LS, and hepatic fibrosis was observed only post-OS.
Conclusions:
- Laparoscopic and open surgery for choledochal cysts in preschool-aged children have comparable short-term complication rates.
- Laparoscopic surgery demonstrates advantages in perioperative recovery and resource utilization.
- LS is a reasonable primary surgical approach for choledochal cysts when patient and disease factors are favorable, necessitating careful patient selection.
Background:
Laparoscopic surgery for choledochal cysts (CC) in young children is a technically demanding procedure, and comparative outcomes with open surgery remain incompletely defined. This study aims to compare outcomes of laparoscopic surgery (LS) and open surgery (OS) in children ≤ 5 years.
Methods:
A retrospective cohort study was conducted using the Pediatric Health Information System (PHIS) database to identify children with CC who underwent definitive surgical excision between 2015 and 2025. Patients were grouped by operative approach (LS vs. OS). Demographic characteristics, operative techniques, and postoperative outcomes were compared.
Results:
A total of 533 children were included (LS: 251, 47.1%; OS: 282, 52.9%). LS was more often performed during elective admissions (p < 0.001) and in older children (p < 0.001). Preoperative malnutrition (p = 0.032), cholangitis (p = 0.029), and the need for drainage procedures prior to definitive surgery (p = 0.050) were more common in OS. Hepaticoduodenostomy predominated in LS, while hepaticojejunostomy was more common with OS (p < 0.001). There were no differences in overall 90-day postoperative complications (p = 0.618). LS was associated with fewer blood transfusions (p = 0.049), total parenteral nutrition (p = 0.005), and mechanical ventilation (p = 0.001), decreased odds of intensive care unit admission (p < 0.001), and shorter length of stay (p < 0.001). At 90-day follow-up, biliary calculi were more common after LS (2.8% vs. 0.4%, p = 0.029), while hepatic fibrosis was observed only after OS (3.5%, p = 0.002).
Conclusion:
In preschool-aged children with choledochal cysts, laparoscopic and open approaches demonstrate similar short-term complication rates. Laparoscopy is associated with improved perioperative recovery and reduced resource utilization. When patient and disease factors permit, LS represents a reasonable primary operative approach, although careful patient selection remains essential.