Laparoscopic versus Open Roux-en-Y hepatojejunostomy for children with choledochal cysts: intermediate-term follow-up results

Laparoscopic hepatojejunostomy (LH) for children with choledochal cysts (CDC) has been gaining popularity recently. However, its safety and efficacy remain unknown. The purpose of this study was to evaluate the intermediate-term results of LH for CDC children.

We reviewed 218 patients who underwent LH between October 2001 and October 2009 and 200 patients who underwent open hepatojejunostomy (OH) between September 1993 and September 2001. Ultrasonography, upper gastrointestinal contrast studies, and laboratory tests were performed during the follow-up period. Age, operative blood loss, operative time, postoperative hospital stay, time to full feed, duration of drainage, postoperative complications, and perioperative laboratory tests were evaluated in both groups.

The median follow-up periods of the LH and OH groups were 38 and 146 months, respectively. There was no significant difference in age between the two groups. Interestingly, the operative time of the LH group decreased significantly with increasing number of cases (P < 0.01). The most recent operative time of the LH group did not differ from that of the OH group (3.04 vs. 2.95 h, P = 0.557). The operative blood loss of the LH group was significantly less (P < 0.001). The postoperative hospital stay, resumption of alimentation, and duration of drainage in the LH group were significantly shorter (P < 0.001, respectively). Two of 218 (0.9%) LH patients developed bile leak. This was significantly less than 11 of 200 (5.5%) in the OH group (P < 0.01). The morbidities of LH group were significantly lower than those of the OH group. Postoperative liver function tests and serum amylase levels normalized in both groups (P < 0.001).

Laparoscopic hepatojejunostomy is safe and effective. Its intermediate-term results are comparable to open surgery.