Laparoscopic Excision of Choledochal Cysts with Roux-en-Y Hepaticojejunostomy in Children: Surgical Technique, Experience, and Outcomes.

AIMS

This study aimed to evaluate the feasibility, safety, and efficacy of laparoscopic excision of choledochal cysts (CDCs) with Roux-en-Y hepaticojejunostomy (HJ) in pediatric patients at a tertiary care teaching institution in India.

METHODS

We conducted a retrospective review of electronic medical records from November 2019 to November 2024, involving 43 children who underwent laparoscopic CDC excision with Roux-en-Y HJ in a single surgical unit. Data collected included demographic information, clinical presentation, imaging features, CDC classification, preoperative interventions, surgical details, postoperative complications, and follow-up outcomes. Laparoscopic HJ was performed by a single surgeon with a four-port technique with extracorporeal jejunojejunostomy.

RESULTS

The cohort consisted of 43 children (26 girls), with a mean age of 5.5 (0.33-17) years and a mean weight of 16.5 (6-48) kg, including seven infants. Preoperative interventions were required in 11 (25.6%) children. The mean operative time was 406 (315-545) min, with an 11.6% conversion rate to open surgery due to difficult anatomy. Postoperative complications were observed in 34.8% of patients, primarily minor (Clavien-Dindo Grade I or II), including bile leak in 6.9% of patients, managed without further intervention. Major complications included adhesive obstruction and anastomotic stricture, requiring reoperations in two patients. The mean time to full enteral feeds was 6.5 (4-9.5) days, and the mean hospital stay was 9.3 (5-25) days. Follow-up (mean duration: 27.2 months) showed no intrahepatic biliary radical dilation or recurrent cholangitis or pancreatitis, with normal liver function tests in all patients except one who developed liver decompensation and was lost to follow-up.

CONCLUSIONS

Laparoscopic excision of CDC with Roux-en-Y HJ in children is a safe, feasible, and effective approach, offering numerous benefits while presenting manageable risks and complications. With advancements in minimally invasive techniques and increased surgeon expertise, this method holds promise for becoming a widely adopted standard in pediatric surgery.