Does bile exposure during surgery affect the postoperative recovery and complications of pediatric patients with choledochal cysts treated by laparoscopic surgery?

Purpose We aimed to investigate the impact of intraoperative bile exposure (BE) on postoperative recovery and complications in pediatric patients with choledochal cysts (CCs). Methods We reviewed the medical records of CC patients who underwent laparoscopic surgery at our institutions between 2016 and 2024. The patients were divided into two groups according to the presence (BE group) or absence (control group) of intraoperative BE. Results Forty patients were enrolled (control group, n = 29; BE group, n = 11). The clinical data were compared between the two groups. The patients’ background characteristics, operative data, intraoperative adverse events, and postoperative complications during hospitalization did not significantly differ between the two groups. The incidence of postoperative cholangitis in the long-term postoperative period was significantly higher in the BE group than in the control group (2(6.9%) vs. 4(36.4%), p  = 0.03). However, they did not have stenosis at the anastomotic site or intrahepatic stones. Conclusion intraoperative BE did not affect the postoperative recovery of patients with CC treated by laparoscopic surgery. However, it did affect the rate of occurrence of cholangitis in the postoperative chronic period. Further investigations are necessary to clarify the mechanism underlying the development of postoperative cholangitis in pediatric patients with CC.