Abstract: Objective:To explore the clinical efficacies of open and laparoscopic surgery in the treatment of adult patients with congenital choledochal cyst.
Methods:The clinical data of 36 adult patients with congenital choledochal cysts who were admitted to the Sir Run Run Shaw Hospital from February 2008 to February 2015 were retrospectively analyzed. Twentyfour patients underwent common bile duct cyst resection+cholecystectomy
+biliojejunal RouxenY anastomosis (open surgery group), 12 patients underwent laparoscopic common bile duct cyst resection+cholecystectomy+biliojejunal RouxenY anastomosis (laparoscopy group). The intraoperative conditions, detection indexes and postoperative recovery indexes in the 2 groups were analyzed. The followup by regular outpatient examination and telephone interview were done up to March 2015. Nonnormal distribution data were described as M(P25，P75). Comparison between groups was analyzed using the MannWhitney U test and Fisher exact probability . Measurement data with normal distribution were presented as ±s and analyzed using t test. Count data were evaluated by the ratio and proportion.
Results:The operation time of the open surgery group and laparoscopy group were 238 minutes (191 minutes, 283 minutes) and 270 minutes (225 minutes, 326 minutes), with a significant difference between the 2 groups 〖HJ*4〗(Z=-1.360, P>0.05). The volume of intraoperative blood loss in the open surgery group and laparoscopy group were 200 mL (113 mL, 363 mL) and 75 mL(50 mL, 138 mL)，with a significant difference between the 2 groups (Z=-3.377, P<0.05). The level of Creactive protein in the open surgery group and laparoscopy group were 94 mg/L (81 mg/L, 104 mg/L) and 29 mg/L (21 mg/L, 61 mg/L)，with a significant difference between the 2 groups (Z=-4.296, P<0.05). The pain scores at postoperative day 3, time to anal exsufflation, time for fluid diet intake and duration of hospital stay of the open surgery group and laparoscopy group were 2.5±0.9, (3.7±1.0)days, (5.0±1.6)days, (10.0±2.7)days and 1.9±0.3, (2.6±1.0)days, (3.6±1.6)days , (7.8±2.2)days, respectively, showing significant differences between the 2 groups (t=3.146, 3.286, 2.450, 2.523, P<0.05). Nine patients in the open surgery group and 3 patients in the laparoscopy group had the complications, with improvement of conditions after symptomatic treatment, showing no significant difference between the 2 groups (P>0.05). All the 36 patients were followed up for a median time of 36 months (range, 1-72 months) with good recovery, without longterm postoperative complications and reoperation.
Conclusion:Laparoscopic surgery in the treatment of adult patients with congenital choledochal cyst is safe and feasible, with the advantages of less intraoperative bleeding, less surgical trauma, fast recovery compared with open surgery.