Short-term Surgical Outcomes after Laparoscopic Excision of Choledochal Cyst and Roux-en-Y Hepaticojejunostomy in Children.

BACKGROUND

Despite being a technically demanding procedure, the laparoscopic approach for choledochal cyst excision (LEC) has gained popularity in the last two decades. We conducted a study to evaluate the outcomes of the initial cohort of LEC and Roux-en-Y hepaticojejunostomy performed at our center.

SUBJECTS AND METHODS

A retrospective observational study was conducted. Medical records of patients who underwent LEC from July 2019 to April 2023 at our institute were retrieved and analyzed.

RESULTS

Twenty-eight patients were included in our study, of which 68% ( = 19) were females. The median age of the cohort was 5.5 years. 26/28 patients (92.8%) were diagnosed with Type 1 Choledochal cyst (CC), and Type 4a CC was noted in two children (7.2%). Majority of our patients were symptomatic. Pain in the abdomen was the predominant symptom noted in 26/28 patients (93%), eight children (28.5%) presented with jaundice. Antenatal diagnosis of choledochal cyst (CC) was established in one child (3%). Anomalous pancreaticobiliary junction was noted in 10/28 patients (35%) on magnetic resonance cholangiopancreatography. Clavien-Dindo Grade 3A and 3B complications were noted in 7% of patients each, Grade 1 in 17.5%, and Grade 2 in 3.5%. The overall morbidity rate was 28%, and there was no mortality. No cases of malignancy were reported. On a 3-month follow-up, 27/28 patients (96.5%) underwent hepatobiliary iminodiacetic acid scan, which showed good tracer clearance.

CONCLUSIONS

Laparoscopic excision of CC in 28 pediatric patients demonstrated safety and efficacy. The average surgery duration was 240 min, with a low conversion rate to open surgery (3.5%). The study confirms that laparoscopic approach as a viable option, although it requires an experienced surgical team.