One-stage minimally invasive surgery is as safe and feasible as two-stage surgery for perforated choledochal cyst in pediatric patients who are hemodynamically stable.

To contribute to the evolving evidence guiding the optimal management of perforated choledochal cyst (PCC), a rare but serious complication of choledochal cyst. We reviewed data from 10 patients with PCC treated at our institution between 2004 and 2024. The patients were categorized into a two-stage (n = 5) group and a one-stage group (n = 5). Surgical outcomes, postoperative complications, and length of hospital stay were compared. The operative time was significantly longer in the one-stage group than in the two-stage group (353 min vs. 282 min, respectively; p = 0.006), whereas blood loss was comparable between the groups. Open surgery was more frequent in the two-stage group than the one-stage group (80% vs. 0%; p = 0.048). Early complications occurred in 40% and 20% of the patients in the two-stage and one-stage groups, respectively (p = 1.000). Anastomotic leakage occurred in one patient from each group. The hospital stay was significantly longer in the two-stage group than in the one-stage group. The late complication incidence did not differ significantly between the groups. Our findings suggest that one-stage surgery is a safe and effective option for PCC in patients who are clinically stable and when performed by experienced surgeons. These findings may assist in the management of PCC.