Comparison of therapeutic effects of laparoscopic and open operation for congenital choledochal cysts in adults

Abstract

Background. Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for treating congenital choledochal cysts (CCCs) have proved to be efficacious in children. Its safety and efficacy in adult patients remain unknown. The purpose of this study was to determine whether the laparoscopic procedure was feasible and safe in adult patients. Methods. We reviewed 35 patients who underwent laparoscopic operation (laparoscopic group) and 39 patients who underwent an open procedure (open group). The operative time, intraoperative blood loss, time until bowel motion recovery, duration of drainage, postoperative stay, time until resumption of diet, postoperative complications, and perioperative laboratory values were recorded and analyzed in both groups. Results. The operative time was longer in the laparoscopic group and decreased significantly with accumulating surgical experience (P < 0.01). The mean intraoperative blood loss was significantly lower in the laparoscopic group (P < 0.01). The time until bowel peristalsis recovery, time until resumption of diet, abdominal drainage, and postoperative stay were significantly shorter in the laparoscopic group (P < 0.01). The postoperative complication rate was not higher in the laparoscopic group than in the open group (P > 0.05). Conclusions. Laparoscopic cyst excision and hepaticojejunostomy are a feasible, effective, and safe method for treating CCCs in adult patients.

Figure 1

CCC classification: type Ia, cystic dilatation of the common bile duct with PBM; type Ib, focal segmental dilatation without PBM; type Ic, fusiform dilatation of the entire extrahepatic bile duct with PBM; type II, diverticular dilation of the common bile duct without PBM; type III, dilatation of the intraduodenal segment of the common bile duct (choledochocele) without PBM; type IVA, combined dilatations of intrahepatic and extrahepatic bile ducts, usually accompanied by PBM; type IVB, multiple dilatations of extrahepatic bile duct, PBM is uncertain; type V, cystic dilatations of the intrahepatic bile ducts (Caroli's disease) without PBM.

Figure 2

Sites and sizes of the trocar ports.

Figure 3

Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy. (a) Suspension of the left hepatic lobe. (b) A trumpet terminal was left after the transection of the common bile duct. (c) Clipping the distal narrow part of the cyst. (d) Amputation of the jejunum using an Endo-GIA linear stapler. (e) Hepaticojejunostomy with a running suture. (f) Jejunojejunostomy using an Endo-GIA linear stapler. (g) An intrabiliary stent tube was then placed.

Figure 4

Open cyst excision and Roux-en-Y hepaticojejunostomy.

Figure 5

Operative times showed a tendency to decrease as the number of cases accumulated.