Hepatic cystic echinococcosis (HCE) imposes a significant health burden on children in endemic regions. This meta-analysis compares perioperative outcomes between laparoscopic (LS) and open surgery (OS) for pediatric HCE to inform surgical management strategies.

Following PRISMA guidelines, we systematically searched PubMed, CNKI, Wanfang, and VIP for studies (February 2019-April 2024) comparing LS and OS in children with HCE. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Pooled analysis was performed for operative time, blood loss, hospital stay, biliary complications, residual cavity effusion, and recurrence.

Eleven studies involving 556 children (LS = 210, OS = 346) were included. LS was associated with significantly reduced intraoperative blood loss (SMD = -1.11, 95% CI: -1.36 to -0.86, P < 0.001) and shorter hospital stay (SMD = -1.12, 95% CI: -1.81 to -0.42, P = 0.002) compared to OS. Operative time was also shorter in the LS group (SMD = -0.36, 95% CI: -0.85 to 0.14, P < 0.001). There were no significant differences in rates of biliary complications (OR = 1.17, 95%CI 0.26–5.35, P = 0.083), residual cavity effusion (OR = 0.34, 95%CI 0.08–1.47, P = 0.149), or recurrence (OR = 0.57, 95%CI 0.21–1.56, P = 0.277).

For selected pediatric HCE patients, laparoscopic surgery offers faster recovery with less surgical trauma and a comparable safety profile to open surgery. These findings support integrating minimally invasive techniques into pediatric surgical practice in endemic, resource-limited settings.