Does Bile Exposure During Surgery Affect the Postoperative Recovery and Complications of Pediatric Patients With Choledochal Cysts Treated by Laparoscopic Surgery?

Introduction In hepatobiliary surgery, bile exposure (BE) may cause complications such as bile peritonitis, slow postoperative recovery, and peritoneal dissemination of cancer cells in adult patients. We investigated the effect of BE on postoperative recovery and complications in pediatric patients with choledochal cysts (CCs) who underwent laparoscopic treatment. Methods We reviewed the medical records of patients with CCs who underwent laparoscopic surgery at our institution and associated institutions between April 2016 and April 2024. Patients were divided into two groups according to the presence (BE group) or absence (control group) of BE during surgery. Results Forty‐three patients were enrolled in this study (control group, n = 25; BE group, n = 18). Patient background characteristics, operative results, and postoperative complications were compared between the two groups. There were no significant differences in the patients' background characteristics and operative results between the two groups. The incidence of postoperative cholangitis was significantly higher in the BE group than in the control group ( n = 1 [4.0%] vs. n = 6 [33.3%], p = 0.003). However, the incidence of stenosis at the anastomotic site and intrahepatic stones was not significantly different. Conclusion BE during surgery did not affect the postoperative recovery of patients with CCs treated by laparoscopic surgery. However, this did affect the rate of postoperative cholangitis. BE may be a factor contributing to the onset of postoperative cholangitis. Further investigations are necessary to clarify the mechanisms underlying the development of postoperative cholangitis in pediatric patients with CC.