The impact of pre-operative cholecystostomy on laparoscopic excision of choledochal cyst in paediatric patients

Abstract

<h3>Purpose</h3><p>This aim of this study was to identify the pre-operative risk factors for conversion during laparoscopic excision of choledochal cyst in paediatric patients.</p><h3>Methods</h3><p>A retrospective single-centre study was carried out. All paediatric patients (< 18 years) who had undergone laparoscopic excision of choledochal cyst between 2004 and 2021 were reviewed. The outcome was conversion to open surgery and pre-operative factors that affected the conversion rate were analyzed.</p><h3>Results</h3><p>Sixty-one patients were included. Conversion was required in 24 cases (39.3%). There was no difference in the conversion rate between the first (before 2012, <em>n</em> = 30) and second (after 2012, <em>n</em> = 31) half of the series (36.7% vs. 42.0%, <em>p</em> = 0.674). Majority was type 1 cyst (86.8%) and the median cyst size was 4.6 cm (IQR: 2.2–6.4 cm). Antenatal diagnosis was available in 18 patients (29.5%). The median age at operation was 23.0 months (IQR: 8.0–72.0 months). Pre-operatively, 19 patients (31.1%) suffered from cholangitis and 5 (8.2%) of them required cholecystostomy. Comparing patients with successful laparoscopic surgery (L) and converted cases (C), there were no differences in the age at operation (<em>p</em> = 0.74), cyst size (<em>p</em> = 0.35), availability of antenatal diagnosis (<em>p</em> = 0.23) and cholangitic episodes (<em>p</em> = 0.40). However, a higher percentage of patients required cholecystostomy in the converted group (L vs. C = 2.7% vs. 16.7%, <em>p</em> = 0.05). Using logistic regression analysis, it was also a risk factor for conversion (OR = 3.5 [1.37–5.21], <em>p</em> = 0.05).</p><h3>Conclusion</h3><p>Pre-operative cholecystostomy is a potential risk factor for conversion during laparoscopic excision of choledochal cyst in children.</p>