Single-port laparoscopic excision of choledochal cysts in neonates versus older infants and children: a comparative safety and feasibility study from a single-center 5-year experience

Objective This study compared the feasibility, safety, and efficacy of single-port laparoscopic choledochal cyst excision with Roux-en-Y hepaticojejunostomy (SPCH) between neonates and older infants and children to determine whether early surgical intervention in the neonatal period carries additional operative risks or offers comparable outcomes to the current standard of care. Methods A retrospective comparative cohort study was conducted on children who underwent SPCH between March 2020 and June 2024. Perioperative data, including operative time, blood loss, complications, and postoperative hospitalization were analyzed. Results A total of 70 patients were included, comprising 21 neonates (≤28 days) and 49 older infants/children (>28 days). Neonates had larger cyst diameters without statistical significance (5.49 vs. 4.49 cm, P = 0.052), higher rates of prenatal detection (85.7% [18/21] vs. 49.0% [24/49], P = 0.004), whereas older infants/children more frequently presented with pancreaticobiliary maljunction (44.9% [22/49] vs. 4.8% [1/21], P = 0.001).Operative outcomes were comparable, with no significant differences in operative time (230.33 vs. 256.43 min) or blood loss (6.43 vs. 6.86 mL). Neonates had no small diameter hepaticojejunostomy anastomoses (0.0% [0/21] vs. 32.7% [16/49], P = 0.003) but longer postoperative stays (8.24 vs. 6.69 days, P = 0.04). Complication rates were similar (4.8% [1/21] vs. 2.0% [1/49], P = 0.53). Conclusion For neonatal CDC, SPCH is a practical and secure solution offering cosmetic benefits without increasing procedural risks. Neonatal anatomical features facilitate technical success, though heightened postoperative surveillance requirements account for longer hospitalization.