A single-center retrospective cohort study of laparoscopic versus open excision of choledochal cysts in children: experience from a national children's hospital.

Purpose: Laparoscopic excision of choledochal cysts (CC) has become increasingly popular in pediatric surgical practice in Korea. This study aimed to evaluate the efficacy and safety of laparoscopic CC excision in pediatric patients by comparing its outcomes with those of open surgery at a national children's hospital. Methods: We retrospectively reviewed patients aged <19 years who underwent CC excision with Roux-en-Y hepaticojejunostomy between 2010 and 2024 at our center. The patients were divided into laparoscopic and open surgery groups, and their clinical and perioperative outcomes were compared. Variables included demographics, clinical characteristics, operative details, and preoperative and postoperative laboratory findings. Results: Seventy-nine patients (17 boys and 62 girls) were included, of whom 33 (41.8%) underwent laparoscopic excision, and 46 underwent open surgery. There were no clinically meaningful differences between the groups in terms of laboratory parameters or the incidence of cholangitis and pancreatitis. The mean operative time was significantly longer in the laparoscopic group (322.3 ± 63.3 minutes vs. 278.2 ± 53.9 minutes, P = 0.002) but decreased with increasing experience. There were no significant differences in the incidence of short- or long-term complications between the groups. Conclusion: Laparoscopic CC excision is a safe and effective alternative to open surgery in pediatric patients. Although the operation was initially longer, it decreased with accumulated surgical experience. This study shows that laparoscopic CC excision can be safely and effectively implemented in a national children's hospital located outside the capital region, supporting its broader application across diverse clinical settings.