The Treatment Of Laparoscope In Children With Congenital Choledochal Cyst

Objective: Congenital choledochal cyst is one of the most common anomalies of biliary system in children. Cyst excision with hepaticojejunostomy has been the classic procedure for treating choledochal cysts. With the development of laparoscopic surgery, many conditions can be dealt with using minimally invasive surgery now. Indeed, the more complex conditions can be managed such as choledochal cyst laparoscopically with the maturation of laparoscopic techniques. We collected the data of a group of patients in congenital choledochal cyst. The aim of this study is to evaluate the clinical therapeutic effect whether laparoscopic assisted management of choledochal cysts is as well as conventional open surgery with this disease in children.Materials and Methods: The retrospective analysis was performed on patients who undergone surgical treamtment of choledochal cysts admitted in the Children’s Hospital of Soochow University between January 2004 and December 2014. According to the selection of operations, 61 cases were assigned to laparoscopic procedures and the other 50 cases to conventional open procedures. Comparing differences in duration of surgery, delayed postoperative oral feeding, postoperative hospital stay, volumes of blood, postoperative recovery, postoperative complications between them. The clinical information and follow-up were collected and analyzed for evaluating the clinical features regarding the pathological type and therapeutic effect with the software of SPSS 17.0 for windows. Statistical significance was accepted when P value was less than 0.05 sum test.Results: A total 0f 111 patients with congenital choledochal cyst who were admitted in the Children’s Hospital of Soochow University between January 2004 and December 2014, in which 61 patients were underwent completely laparoscopic treatment(LP group), the rest were operated open surgery(OP group). All children were alive during the hospitalization and follow-up periods. Between the two groups, the average duration of operation is 4.20±0.79 h and 3.47±0.83 h, the mean volumes of blood loss was 8.80±4.13 ml and 19.04±13.07 ml, the average time in delayed postoperative oral feeding was 3.25±1.14 d and 4.64±1.24 d, the average time for parenteral nutrition was 4.28±1.14 d and 5.42±1.23 d, the rate of incidence of malformation during the operation is 5% and 0%. The date of the two groups had significant difference(P <0.05).It is 4.9%(3/6)of the incidence of postoperative complications in laparoscopic treatment, the other one is 10%(5/50). According to our study, the group of laparoscopic treatment has more significant advantages in treatment effectiveness and the outcomes of follow-up comparing with conventional open surgery.Conclusion:1、The treatment of Laparoscope minitraumatic technique in choledochal cysts is accurate, safe and effective.2、Comparison with conventional open surgery, laparoscope minitraumatic technique is a new approach to diagnose and treat in choledochal cyst which could be decreasing the surgical trauma, exposuring the surgical field, shortening the length of stay after operation, even reducing the postoperative complications. What’s more, it could be exploring to the other organs in children who were suffered from other malformations and dealing with them together.3、It has an obvious advantage to correct stricture of extrahepatic bile duct in lparoscopic surgery. Laparoscopic intraoperative cholangiography may identify the stricture of intrahepatic and extrahepatic bile duct and pancreatic duct, stones and the other other anatomical variations. Besides, laparoscope may provide an vision with enlargement which could help the cyst excision completely, avoid the injury of the pancreatic duct, hepatic portal vascular and reshape the stricture of extrahepatic bile duct.4、 The short loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts which could be individually for patients of different ages should reduce some possibilities and complications such as cholestasis, biliary branch in torsion and necrosis, the formation of stones and intestinal obstruction etc that may has the same anti-reflux effect with the long Roux biliary branch in conventional operation.5、There are some conditions such as a huge cyst, bile duct stricture which were admitted the taboos in early stage of laparoscopic operations while these could be resected by the technique of laparoscope with conditions permit.6、It could be excised easily for the sake of mild inflammation of choledochal cyst in neonates and infants. Moreover, the application of more sophisticated equipments may be helpful in hepatojejunostomy reconstruction. Therefore, early surgical intervention by laparoscopy is safe and warranted that could be safely applied in neonates and infants with satisfactory result.