Choledochal Cyst in Children Under Six Months: Is Da Vinci Robot-Assisted Surgery More Advantageous?

Purpose: Surgery for choledochal cysts (CDC) in children younger than 6 months is relatively rare. We report our experience and compare the results between Da Vinci robot-assisted hepaticojejunostomy (RAHJ) and laparoscopic-assisted hepaticojejunostomy (LAHJ) in children younger than 6 months to treat CDC. Methods: A retrospective study was conducted on all children under 6 months of age who underwent RAHJ or LAHJ at the Children's Hospital, Zhejiang University School of Medicine, from July 2018 to November 2023. Results: We reviewed 34 patients who underwent RAHJ surgery and 50 patients who underwent LAHJ surgery (P = .243). RAHJ group of the median operation time was 182 minutes (range 161-221), and LAHJ group was 168 minutes (range 143-191) (P = .02). The RAHJ group had a significantly shorter median postoperative hospital stay of 9 days (range 7-10) than the LAHJ group, 11 days (range 10-14), p < .001. The median hospitalization cost in the RAHJ group was significantly higher than that in the LAHJ group (75,474 CNY versus 28,984 CNY, p < .01). The median follow-up time was 18 months in the RAHJ group and 48 months in the LAHJ group (p < .01). All patients in the RAHJ group recovered well and were discharged. One patient in the LAHJ group developed biliary fistula 21 days after surgery and recovered well after reoperation. Conclusions: For children under 6 months old, on the basis of no consideration of cost, RAHJ has fast postoperative recovery and fewer postoperative complications, which is more recommended.