322 Totally Laparoscopic Excision of Choledochal Cysts with Roux-en-Y Hepaticojejunostomy: A 21-Year Single-Centre Experience

Abstract Background Choledochal cysts are rare congenital dilatations of the biliary tree, predominantly affecting females. Laparoscopic excision with Roux-en-Y hepaticojejunostomy has become the preferred approach over open surgery due to its minimally invasive nature and favorable outcomes. This study presents a 21-year, single-centre experience evaluating the safety, surgical technique, and long-term outcomes of totally laparoscopic choledochal cyst excision with Roux-en-Y reconstruction. Method A retrospective analysis was performed on 93 patients who underwent primary laparoscopic choledochal cyst excision between March 2003 and December 2024. Data collected included demographics, clinical presentation, imaging, operative details, and postoperative outcomes. Results Among 93 patients, 89 (95.7%) were female. Presenting symptoms included abdominal pain (65%), jaundice (31%), and pancreatitis (2%). All patients underwent MRCP; 27 had additional endoscopic ultrasonography. Cyst types were Todani type I (49), type II (38), type IV-A (5), and type IV-B (1). All procedures were completed laparoscopically using a standardized 5-port technique. Operative time ranged from 110 to 136 minutes, with blood loss between 120 and 380 ml; no transfusions were needed. Retrocolic Roux-en-Y hepaticojejunostomy was performed in all cases. Postoperative complications included five bile leaks and one pancreatitis, all managed successfully without mortality. One patient developed an anastomotic stricture five years postoperatively, treated radiologically. Conclusions Totally laparoscopic excision of choledochal cysts with Roux-en-Y hepaticojejunostomy is a safe, effective, and minimally invasive procedure with excellent long-term outcomes and minimal morbidity when performed in experienced centres.