WOFAPS 2025 8th World Congress of Pediatric Surgery

Mohamed Abdelaziz ¹, Rachida Lamiri ², Mohamed Abdelmaaboud ¹, Mohamed Dabous ¹, hayet zitouni ³

¹ Al Azhar University, Cairo
² Department of pediatric surgery university hospital of Monastir
³ Department of pediatric surgery, Hedi Chaker hospital, Sfax

Background: Choledochal cysts (CC) are rare congenital anomalies of the biliary tract that often require surgical intervention for excision and biliary reconstruction. This multicenter retrospective study aims to evaluate and compare the outcomes of laparoscopic versus open surgical treatment for CC in children.

Methods: We retrospectively reviewed the medical records of 80 pediatric patients diagnosed with choledochal cysts and treated between 2014 and 2024 across three pediatric surgery centers. Patients were categorized into two groups: laparoscopic (44 cases) and open (36 cases). We analyzed patient demographics, cyst type, surgical approach, operative time, intraoperative complications, postoperative outcomes (including hospital stay, postoperative pain, and complication rates), and long-term follow-up data on liver function and symptom resolution.

Results: The two groups were comparable in terms of age (ranging from 40 days to 162 months), sex distribution, and cyst type, with the majority presenting with Todani type I cysts, followed by type IV cysts. The choice of anastomotic technique varied according to the surgical approach: Roux-en-Y hepaticojejunostomy (RYHJ) was more frequently performed in open surgeries (32 cases vs. 4 cases), while hepaticoduodenostomy (HD) was predominantly used in laparoscopic procedures (38 cases vs. 6 cases).

Notably, the laparoscopic group demonstrated significantly shorter postoperative hospital stays and reduced postoperative pain levels. There were no significant differences in the rates of major postoperative complications, including bile leaks or anastomotic strictures. Both groups showed favorable long-term outcomes in terms of liver function and resolution of preoperative symptoms.

Conclusion: Laparoscopic excision of choledochal cysts in children is a safe and effective alternative to open surgery, offering similar outcomes with less invasiveness, faster recovery, and better cosmetic results. Recent advances, including the use of indocyanine green (ICG) fluorescence, have improved the safety and precision of laparoscopy, supporting its growing role as a standard technique in specialized pediatric centers.