Comparison of long-term biliary complications between open and laparoscopic choledochal cyst excision in children

Abstract

Purpose Cyst excision with hepaticojejunostomy has been the classic procedure for treating choledochal cysts, and the use of laparoscopic treatment has been favored recently. The purpose of this study was to compare the long-term biliary complication of laparoscopic operation with open surgery for choledochal cyst presenting in children. Methods A retrospective study comparing the laparoscopic and open procedures was performed in 185 patients with choledochal cyst in a single children's hospital. There were 109 patients who were operated with open surgery, and 76 patients operated with laparoscopic surgery. The primary outcome was long-term biliary complications and the secondary outcome included operative time, intraoperative transfusion, length of hospital stay, and other late postoperative complications. Results In the patient's demographics, there was no significant difference between the 2 groups. Notably, it was shown that the operative time was longer in the laparoscopic group. The number of patients requiring blood transfusion intraoperatively was lower in the laparoscopic group. It was noted that the hospital stay was not statistically different. The duration to resumption of diet and duration of drainage were longer in the laparoscopic group. Biliary complications were shown to be significantly higher in the open group. The risk factor for long-term biliary complications was noted with the intraoperative transfusion. Conclusion The use of a laparoscopic choledochal cyst excision with hepaticojejunostomy is a safe and feasible technique in a young patient. The long-term biliary complication was lower compared to open surgery, rendering this a good option for pediatric patients.

Biliary Rhabdomyosarcoma in Pediatric Patients: A Systematic Review and Meta-Analysis of Individual Patient Data

“…In line with this, relevant studies did not show a significant association between abdominal surgery in pediatric oncological patients and serious long-term sequelae affecting the hepatobiliary system (38)(39)(40). The resection of extrahepatic bile ducts with biliary enteric anastomosis, which is the most commonly required procedure for BRMS, has been applied for decades in children and proofed to be a safe surgery with good long-term outcome (41)(42)(43).…”

Our Experience with Cyst Excision and Hepaticoenterostomy for Choledocal Cyst: A Single Center Case Review of 16 Patients

“…There is a scarcity of papers comparing hepaticojejunostomy and hepaticoduodenostomy after excision of the choledocal cyst in a single center, the majority of which come from the Far East. There are both advantages and disadvantages for each of the techniques, rendering the choice between them still a matter of debate [ 3 ].…”

“…Conventional hepatobiliary surgeons often opt for the Roux-en-Y jejunostomy due to its long history of safeness, being the gold standard for biliary reconstruction for many years. Biliary duodenostomy has been proposed to be a more physiologic option during reconstruction [ 3 ]. We aim to report our experience with pediatric choledocal cyst over a 10-year period and describe our experience with the presentation and management of choledocal cyst and our short and intermediate outcomes of both biliary drainage procedures after choledocal cyst excision.…”

Modified single-port versus multiport laparoscopic choledochal cysts excision and Roux-en-Y hepaticojejunostomy: a retrospective comparative cohort study

“…Choledochal cyst (CDC) is one of the most common congenital biliary malformations in the Asian population, with an incidence as high as 1:1,000 (1). Early diagnosis and surgical intervention are the best ways to prevent perioperative complications and improve prognosis (2,3). Cyst excision and Roux-en-Y hepaticoenterostomy is the first-line treatment for patients with CDC (4).…”

“…Cyst excision and Roux-en-Y hepaticoenterostomy is the first-line treatment for patients with CDC (4). With the rapid advance in surgical technique and equipment, laparoscopic cyst excision and Roux-en-Y hepaticoenterostomy has now been accepted as the preferred approach and provides favorable short-and long-term outcomes (3,5). Singleport laparoscopic surgery is a new technique in which the entire procedure is performed through an incision with a single port containing 3 or 4 small ports.…”