A Single-Center Trial on Conservative Treatment and Prognosis of Severe Bile Leak After Laparoscopic Radical Resection of Congenital Choledochal Cysts.

PURPOSE: To explore the management and prognosis of severe bile leak after surgery in patients with congenital choledochal cysts (CC). METHODS: Patients with CC who underwent severe bile leak (peritoneal drainage exceeding 100 mL/d or 10 mL·kg-1·d-1 for more than 3 consecutive days) after laparoscopic hepaticojejunostomy (LHJ) in our center between 2013 and 2024 were included. Patients were divided into two subgroups based on management (reoperation or non-surgical). A cohort of CC patients with no complication after LHJ from 2020 to 2023 were included as control group, with 2:1 number of the bile leak cohort. The imaging data, perioperative clinical symptoms, drainage volume, reoperation and follow-up results were collected. RESULTS: From 2013 to 2024, 707 children diagnosed with CC underwent LHJ at our hospital. Severe bile leak occurred in 29 (4.1%) patients: 24 (82.8%) were treated non-surgically, 5 (17.2%) required reoperation. In non-surgical cases, 16 (16/24) patients were cured conservatively with peritoneal drainage (median drainage duration: 14 days, IQR 10.5-22.5) while 8 (8/24) patients underwent peritoneal puncture (median drainage duration: 17.5 days, IQR 15-20.75). The remaining 5 (5/29) cases underwent reoperation (open or laparoscopic) after conservative measures failed, with a median interval to reoperation of 11 (8, 18.5) days. The median follow-up period for the non-surgical treatment group was 3.17 (1.23, 6.88) years, while reoperation group was 9.12 (4.18, 9.5) years. Twenty of the twenty-four non-surgical patients (83%) remained complication-free, while 4 patients occurred cholangitis, bile duct calculi and anastomotic stenosis, with the earliest onset at 4 months and a mean onset of 2 years postoperatively. Among these 4 patients, 2 required secondary surgical intervention. In the surgical group, 4 of the 5 patients remained free of complications during follow-up, while 1 patient was lost to follow-up. CONCLUSION: Continuous conservative management is effective for severe bile leak, but anastomotic stenosis risk persists. Timely surgery is needed for infected cases or suspected aberrant bile ducts.