When is the best time to perform laparoscopic excision of choledochal cyst?

Abstract

BACKGROUND/PURPOSE: Laparoscopic excision and Roux-en-Y hepaticojejunostomy is now the preferred method for the management of choledochal cyst. We undertook this study to investigate the best time of surgery which remains undetermined. METHODS: 98 cases were involved in this retrospective study from 2010 to 2013. 3 (3.1%) cases were converted to open. 95 cases with successfully laparoscopic surgery were divided into 4 groups: Group A (1 month–5 months); Group B (5 months–1 year); Group C (1 year–5 years); Group D (5 years–14 years). Operative time, intraoperative blood loss and short-term postoperative complications were recorded and analyzed. RESULTS: In 95 cases with successfully laparoscopic surgery, Bile leakage occurred in 6 (6.3%), chylous ascites in 1 (1.1%), 1 (1.1%) case suffered internal abdominal hernia six days postoperatively. 1 (1.1%) patient had Roux loop necrosis 3 months postoperatively. The incidence of postoperative complications in Group A was significantly higher than other groups (P<0.001), whilst the operative time was shortest in Group B (P<0.001). There was no significant difference in intraoperative blood loss and complication rate. CONCLUSIONS: The best time for laparoscopic excision of CC in children seems to be 6 months to 1 year old and infants with early diagnosis before 6 months should have surgery delayed.