Aim: Congenital choledochal cysts are considered an indication of surgery for recurrent cholangitis and/or pancreatitis and the potential development of bile duct cancer. Since our first report in the world of a successful adult case in 1996, we have accumulated clinical experience with a total of 20 patients with laparoscopic surgery for choledochal cysts. We attempted to elucidate our clinical outcomes of the procedure.
Methods: Surgical parameters including operation time, blood loss, complications, postoperative hospital stay, rate of open conversion were compared between the former period (group A:1996 to 2000) and the latter period (group B:2001 to 2007).
Results: Of 20 patients (6 men, 14 women, average age 33 years), 10 cases were allocated to group A and B, respectively. There was a statistically significant decrease in operation time (587 vs 464 min, p=0.049) from group A to group B. Blood loss (485 vs 241 ml, p=0.133) and postoperative hospital stay (48 vs 14 days, p=0.053) tended to decrease, but the difference was not significant. The procedure was converted to open in 3 patients in group A (40%) and 1 patient in group B (10%) due to severe adhesion, bleeding, anatomical disorientation and pancreatic duct injury. The major postoperative complications occurred in 2 patients in group A (1 bile leakage and 1 pancreatic duct injury) and in 2 patients in group B (1 postoperative bleeding and 1 postoperative pancreatic fistula). There was no mortality in this study.
Conclusions: Laparoscopic surgery for choledochal cysts still remains a challenge mainly due to technical difficulties, but we have shown promising results in this study. Both advances in surgical devices and our learning curve will contribute to future progress in this minimally invasive procedure.