Choledochal Cyst in Children Under Six Months: Is Da Vinci Robot-Assisted Surgery More Advantageous?

Purpose: Surgery for choledochal cysts (CDC) in children younger than 6 months is relatively rare. We report our experience and compare the results between Da Vinci robot-assisted hepaticojejunostomy (RAHJ) and laparoscopic-assisted hepaticojejunostomy (LAHJ) in children younger than 6 months to treat CDC.

Methods

A retrospective study was conducted on all children under 6 months of age who underwent RAHJ or LAHJ at the Children's Hospital, Zhejiang University School of Medicine, from July 2018 to November 2023.

Results

We reviewed 34 patients who underwent RAHJ surgery and 50 patients who underwent LAHJ surgery (P = .243). RAHJ group of the median operation time was 182 minutes (range 161-221), and LAHJ group was 168 minutes (range 143-191) (P = .02). The RAHJ group had a significantly shorter median postoperative hospital stay of 9 days (range 7-10) than the LAHJ group, 11 days (range 10-14), p < .001. The median hospitalization cost in the RAHJ group was significantly higher than that in the LAHJ group (75,474 CNY versus 28,984 CNY, p < .01). The median follow-up time was 18 months in the RAHJ group and 48 months in the LAHJ group (p < .01). All patients in the RAHJ group recovered well and were discharged. One patient in the LAHJ group developed biliary fistula 21 days after surgery and recovered well after reoperation.

Conclusions

For children under 6 months old, on the basis of no consideration of cost, RAHJ has fast postoperative recovery and fewer postoperative complications, which is more recommended.