Laparoscopic one-stage operation for completely perforated choledochal cyst: two cases report and review of the literature

Choledochal cyst (CDC) perforation is a rare but serious complication, and the optimal surgical strategy remains controversial. To our knowledge, no case of laparoscopic one-stage surgery for a completely perforated CDC with a perforation time exceeding 24 h has been reported. We report two cases with complete perforation of a CDC, both of whom had a perforation time of more than 24 h. The two cases were both female, aged 71 months, and 18 months, respectively. They both presented with acute abdominal pain and vomiting. Imaging revealed cystic dilatation of the common bile duct along with ascites. They were managed by one-stage laparoscopic resection of the cyst with biliary reconstruction without conversion to open surgery. No severe complications such as bile leakage, anastomotic stricture, or pancreatitis were observed. At 1-year follow-up, both children showed excellent recovery, with normal liver function and no abnormalities on imaging. This study suggests that one-stage laparoscopic management may be feasible in carefully selected, hemodynamically stable patients for patients with perforated CDC and a perforation time of over 24 h treated by an experienced pediatric laparoscopic team.