Prediction of Postoperative Drainage in Children: The role of Cyst Diameter and Age

Objective: This study aimed to explores the placement and early removal criteria of abdominal drainage tubes after robotic-assisted laparoscopic cyst excision of the common bile duct, providing more scientifically sound and individualized guidance for clinical practice. Methods: A retrospective cohort study was employed, including 129 children who underwent Da Vinci robot-assisted laparoscopic choledochal cyst radical excision at Wuhan Children's Hospital between October 2020 and September 2024. All patients received routine abdominal drainage postoperatively. According to the daily drainage volume, the children were divided into a low-drainage group (< 2 mL·kg⁻¹·d⁻¹) and a high-drainage group (≥ 2 mL·kg⁻¹·d⁻¹). Results: Univariate analysis showed significant differences between the two groups in cyst diameter, age, preoperative globulin (GLB), and hemoglobin (HGB) (p < 0.05), with marginal significance for preoperative total bilirubin and aspartate aminotransferase (AST) (p < 0.1). Multivariate analysis further revealed a significant correlation between cyst diameter, age, and postoperative drainage volume. Based on the results of the multivariate analysis and clinical significance, cyst diameter, age, BMI, hemoglobin (HGB), and globulin (GLB) were selected as predictors to construct the nomogram model. The model validation results showed that the nomogram model had good discrimination, with a C-index of 0.78 and an AUC of 0.78 (95% CI: 0.69-0.87), confirming its reliable predictive performance. Conclusion: After robotic-assisted laparoscopic cyst excision of the common bile duct, the formulation of drainage management strategies should take into account multiple factors such as cyst diameter, age, preoperative physiological parameters, and individual health status, to develop scientific and individualized drainage plans.