Outcomes of laparoscopic versus open resection of pediatric choledochal cyst | 577 Patients | 28% Laparoscopic | 72% Open | Retrospective National Database 2016 - 2018 | Results: | Open Resection | 86% Roux-en-y Hepaticojejunostomy (RYHJ) (p < 0.001) | Laparoscopic | 71% Hepaticoduodenostomy (HD) (p < 0.001) | Open Resection: | Longer length of stay (LOS) | Higher total cost | More complications | No significant difference (open vs lap) in post-op cholangitis or mortality. | Conclusion: Laparoscopic approach is safe and effective for choledocal cyst resection and it may be associated with lower LOS, fewer costs & fewer complications. HD anastomosis is more commonly performed in the laparoscopic approach and RYHJ in the open approach. | https://www.jpedsurg.org/article/S0022-3468(22)00799-0/fulltext | @StayCurrentMD | Source: Ramsey WA et al. | DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, USA | @gigenace | Cincinnati Children's | Journal of Pediatric Surgery
Outcomes of laparoscopic versus open resection of pediatric choledochal cyst
Infographic · Jun 2023 · 1 min read
In brief
In brief
National database analysis of 577 pediatric choledochal cyst resections found laparoscopic approach associated with shorter hospital stays, lower costs, and fewer complications versus open surgery. Anastomotic technique varied by approach, with hepaticoduodenostomy favored laparoscopically and Roux-en-Y hepaticojejunostomy used more often in open cases.
- Laparoscopic choledochal cyst resection reduces hospital stay, costs, and complications compared to open surgery in pediatric patients.
- Hepaticoduodenostomy is preferred in laparoscopic cases (71%) while Roux-en-Y hepaticojejunostomy dominates open procedures (86%).
- Roux-en-Y reconstruction carries higher risk of sepsis, wound infection, and respiratory complications than hepaticoduodenostomy.
- No significant difference in post-operative cholangitis or mortality between laparoscopic and open approaches.
- Only 28% of pediatric choledochal cyst cases used laparoscopy despite demonstrated safety and superior outcomes (2016-2018 data).
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with a calendar icon, gallbladder illustration, and surgical team graphic. Results are displayed with large percentage statistics and arrows connecting surgical approaches to their outcomes. A yellow conclusion box appears on the right side.
New infographic by Cecilia Gigena
"Outcomes of laparoscopic versus open resection of pediatric choledochal cyst"
Authors: Walter A. Ramsey, Carlos T. Huerta, Shreya M. Ingle, Gareth P. Gilna, Rebecca A. Saberi, Christopher F. O'Neil Jr., Antoine J. Ribieras, Joshua P. Parreco, Eduardo A. Perez, Juan E. Sola, Chad M. Thorson
Full article: https://www.jpedsurg.org/article/S0022-3468(22)00799-0/fulltext
Abstract
Background
Untreated pediatric choledochal cyst (CC) is associated with complications including cholangitis, pancreatitis, and risk of malignancy. Therefore, CC is typically treated by surgical excision with biliary reconstruction. Both open and laparoscopic (lap) surgical approaches are regularly used, but outcomes have not been compared on a national level.
Methods
The Nationwide Readmissions Database was used to identify pediatric patients (age 0–21 years, excluding newborns) with choledochal cyst from 2016 to 2018 based on ICD-10 codes. Patients were stratified by operative approach (open vs. lap). Demographics, operative management, and complications were compared using standard statistical tests. Results were weighted for national estimates.
Results
Choledochal cyst excision was performed in 577 children (75% female) via lap (28%) and open (72%) surgical approaches. Patients undergoing an open resection experienced longer index hospital length of stay (LOS), higher total cost, and more complications. Anastomotic technique differed by approach, with Roux-en-Y hepaticojejunostomy (RYHJ) more often utilized with open cases (86% vs. 29%) and hepaticoduodenostomy (HD) more common with laparoscopic procedures (71% vs. 15%), both p < 0.001. There was no significant difference in post-operative cholangitis or mortality.
Conclusions
Although utilized less frequently than an open approach, laparoscopic choledochal cyst resection is safe in pediatric patients and is associated with shorter LOS, lower costs, and fewer complications. HD anastomosis is more commonly performed during laparoscopic procedures, whereas RYHJ more commonly used with the open approach. While HD is associated with more short-term gastrointestinal dysfunction than RYHJ, the latter is more commonly associated with sepsis, wound infection, and respiratory dysfunction.