Risk factors for complications after laparoscopic surgery in children with congenital choledochal cysts.

BACKGROUND

Laparoscopic Roux‑en‑Y hepaticojejunostomy is the standard treatment for pediatric congenital choledochal cysts (CCCs). However, postoperative complications remain a significant clinical challenge. This study aimed to identify independent risk factors and develop a predictive model for complications following laparoscopic CCC excision in children.

METHODS

We conducted a retrospective cohort study of 362 pediatric patients who underwent laparoscopic surgery for CCC between August 2019 and July 2024 at two tertiary centers. Preoperative variables were systematically collected. Univariable and multivariable logistic regression analyses identified predictors of complications, with significant variables (P<0.05) incorporated into a nomogram for risk stratification. Subgroup and Cox regression analyses were used to evaluate factors for specific complications and time-to-event outcomes.

RESULTS

Postoperative complications occurred in 34 patients (9.39%). The most common were biliary-intestinal anastomotic stricture (35.3%), choledocholithiasis (23.5%), and pancreatitis (20.6%). Independent predictors included: cyst wall thickness >5 mm [odds ratio (OR) =4.23, 95% confidence interval (CI): 1.26-6.75; P<0.001], chronic cholecystitis (OR =6.42, 95% CI: 3.39-9.24; P<0.001), Todani type I (OR =6.13, 95% CI: 2.74-10.38; P=0.002), elevated C-reactive protein (CRP) (OR =1.52, 95% CI: 1.12-2.16; P=0.04), and elevated direct bilirubin (DB; OR =2.05, 95% CI: 1.23-4.17; P=0.04). Subgroup analysis confirmed cyst wall thickness, chronic cholecystitis, Todani type I, and CRP consistently predicted all complications, while DB was specifically linked to choledocholithiasis (P=0.02). Cox regression further associated cyst wall thickness >5 mm with higher complication risk (P=0.04).

CONCLUSIONS

Cyst wall thickness >5 mm, chronic cholecystitis, Todani Type I, elevated CRP, and elevated DB were selected as factors to assess the prognosis of children with choledochal cysts, providing important reference value for the prognostic evaluation and clinical management of children with choledochal cysts.