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Background <p>The optimal timing of definitive surgery after external biliary drainage (EBD) for children with completely perforated congenital choledochal cysts (CCs) remains controversial. Prolonged EBD may increase the risk of drainage tube–related complications. This study compared the safety and efficacy of early (≤ 14 days) versus delayed (&gt; 14 days) definitive surgery after EBD.</p> Methods <p>This study is a single-center retrospective cohort study that included all consecutive pediatric patients with complete perforation of choledochal cysts (CC) admitted between January 2018 and February 2025. According to the timing of surgical treatment, patients were divided into two groups: Group 1 consisted of patients who underwent short-term external biliary drainage (EBD), with definitive surgery performed within 14 days after EBD; Group 2 consisted of patients who underwent long-term EBD, with definitive surgery performed more than 14 days after EBD. The collected data included baseline characteristics of patients, diagnostic and therapeutic processes and data, EBD-related complications, postoperative recovery, laboratory parameters, and postoperative complications. All patients underwent single-incision laparoscopic hepaticojejunostomy (SILH), with conversion to open surgery performed when necessary.</p> Results <p>Thirty patients were included (Group 1, <i>n</i> = 10; Group 2, <i>n</i> = 20). No EBD-related complications occurred in Group 1, whereas 8 patients (40.0%) in Group 2 developed drainage tube–related complications (infection, dislodgement, obstruction, electrolyte disturbances, or dehydration; <i>p</i> = 0.029). Intraoperative findings and surgical outcomes were broadly comparable between groups, including operative duration and conversion to open surgery (all <i>p</i> &gt; 0.05). Postoperative recovery metrics (time to full diet, postoperative drain removal, and length of hospital stay) and postoperative complication rates were also similar.</p> Conclusion <p>In experienced centers, definitive surgery within 14 days after EBD appears to be safe and feasible for completely perforated choledochal cysts, and may reduce complications associated with prolonged drainage.</p>

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Timing of definitive surgery after external biliary drainage for completely perforated congenital choledochal cysts: a single-center retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Yifeng Shao,
  • Anxiao Ming,
  • Chengyang Jiang,
  • Kunpeng Yang,
  • Chuanyu Yang,
  • Mei Diao,
  • Long Li

摘要

Background

The optimal timing of definitive surgery after external biliary drainage (EBD) for children with completely perforated congenital choledochal cysts (CCs) remains controversial. Prolonged EBD may increase the risk of drainage tube–related complications. This study compared the safety and efficacy of early (≤ 14 days) versus delayed (> 14 days) definitive surgery after EBD.

Methods

This study is a single-center retrospective cohort study that included all consecutive pediatric patients with complete perforation of choledochal cysts (CC) admitted between January 2018 and February 2025. According to the timing of surgical treatment, patients were divided into two groups: Group 1 consisted of patients who underwent short-term external biliary drainage (EBD), with definitive surgery performed within 14 days after EBD; Group 2 consisted of patients who underwent long-term EBD, with definitive surgery performed more than 14 days after EBD. The collected data included baseline characteristics of patients, diagnostic and therapeutic processes and data, EBD-related complications, postoperative recovery, laboratory parameters, and postoperative complications. All patients underwent single-incision laparoscopic hepaticojejunostomy (SILH), with conversion to open surgery performed when necessary.

Results

Thirty patients were included (Group 1, n = 10; Group 2, n = 20). No EBD-related complications occurred in Group 1, whereas 8 patients (40.0%) in Group 2 developed drainage tube–related complications (infection, dislodgement, obstruction, electrolyte disturbances, or dehydration; p = 0.029). Intraoperative findings and surgical outcomes were broadly comparable between groups, including operative duration and conversion to open surgery (all p > 0.05). Postoperative recovery metrics (time to full diet, postoperative drain removal, and length of hospital stay) and postoperative complication rates were also similar.

Conclusion

In experienced centers, definitive surgery within 14 days after EBD appears to be safe and feasible for completely perforated choledochal cysts, and may reduce complications associated with prolonged drainage.