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

Purpose: This aim of this study was to identify the pre-operative risk factors for conversion during laparoscopic excision of choledochal cyst in paediatric patients. Methods A retrospective single-centre study was carried out. All paediatric patients (<18 years) who underwent laparoscopic excision of choledochal cyst between 2004 to 2021 were reviewed. The outcome was conversion to open surgery and pre-operative factors that affected the conversion rate were analyzed. Results 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, n=30) and second (after 2012, n=31) half of the series (36.7% vs 42.0%, p=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 (p=0.74), cyst size (p=0.35), availability of antenatal diagnosis (p=0.23) and cholangitic episodes (p=0.40). However, a higher percentage of patients required cholecystostomy in the converted group (L vs C = 2.7% vs 16.7%, p= 0.05). Using logistic regression analysis, it was also a risk factor for conversion (OR = 3.5 [1.37 – 5.21], p=0.05). Conclusion Pre-operative cholecystostomy is associated with a higher chance of conversion during laparoscopic excision of choledochal cyst in children