Non-stapled, Total Laparoscopic Roux-en-Y Anastomosis: A Safe and Effective Procedure for Radical Pediatric Choledochal Cyst Excision

Background: Laparoscopic or robot-assisted surgery is the main minimally invasive surgery for pediatric choledochal cyst (CDC). Most surgeries have involved extracorporeal creation of the Roux-en-Y jejunal limb; a few surgeries have been performed by intracorporeal creation of the jejunal limb with an endoscopic stapler. We aimed to assess the safety and effectiveness of laparoscope-assisted Roux-en-Y jejunal limb created intracorporeally by hand-sewing in pediatric minimally invasive surgery for a choledochal cyst (CDC). Methods Patients diagnosed with CDC between January 2020 and April 2022 were included in this retrospective analysis. We collected data on clinical characteristics, operative details, time for performing laparoscopic Roux-en-Y anastomosis without stapling, and postoperative outcomes. Results Hand-sewn laparoscope-assisted Roux-en-Y jejunal limb was performed successfully for 21 patients. The median patient age was 5.8 years. The median age at surgery was 3.3 ± 3.1 years (range 26 days-13.6 years). The types of cysts included 12 Ia, 7 Ic, and 2 IVa. The mean operative duration was 216.5 ± 25.2 min, intraoperative bleeding volume was 7 ± 2.3 ml, average postoperative time to start oral intake was 2.1 ± 0.4 days, average postoperative indwelling drainage tube time was 2.6 ± 1.1 days, and postoperative hospital stay was 5.3 ± 1.1 days. The follow-up period was 6 to 25 months. No patient incurred complications, e.g., anastomotic stenosis or fistula, pancreatitis, cholangitis, or death. Conclusions Total laparoscope-assisted construction of Roux-en-Y limb without stapling, excision of the cyst, and hepaticojejunostomy are feasible and safe in the treatment for pediatric CDC. This procedure may also have the following advantages: rapid recovery of postoperative gastrointestinal function, short hospitalization, no patient age limit, and no additional hospitalization costs.