The efficacy and safety of robotic, laparoscopic, and open surgery for pediatric choledochal cysts: a systematic review and network meta-analysis.

Background: Pediatric choledochal cysts (CCs) are typically managed via surgical treatment, and a growing number of pediatric patients with CC are undergoing robotic surgery. However, whether it offers superior safety and efficacy compared to open surgery and laparoscopic surgery remains unclear. The primary aim of this study was to compare the efficacy and safety of three surgical approaches [open cyst excision with a Roux-en-Y hepaticojejunostomy (OP), laparoscopic cyst excision with a Roux-en-Y hepaticojejunostomy (LA), and robotic cyst excision with a Roux-en-Y hepaticojejunostomy (RO)] for CC in children.

Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched. Two independent reviewers assessed the studies for eligibility and quality and then extracted the relevant data. Confidence in Network Meta-Analysis (CINeMA) and the Newcastle-Ottawa Scale (NOS) were applied for assessing quality. Direct statistical analyses were carried out via Stata 14.0 (StataCorp), while a network meta-analysis was performed through use of using ADDIS 1.16.18 (GetReal Initiative, Innovative Medicines Initiative).

Results: A total of 18 studies were included for analysis. OP had the significantly shortest operative time; RO had the significantly shortest hospital stay; and LA had the significantly lowest incidence of postoperative bowel obstruction.

Conclusions: RO is effective and safe for the management of CC. The opportunity to convert to open surgery should not be missed due to fears of excessive bleeding or increased postoperative bile leakage.