Early and Intermediate Outcomes of Laparoscopic Surgery for Choledochal Cysts with 400 Patients

Objective: The aim of this study is to report early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 cases. Patients and Methods: The operation was performed using four ports. The cystic duct was identified and divided. The liver was suspended by two stay-sutures: one on the round ligament and the other on the distal cystic duct. The choledochal cyst was isolated and removed completely, and biliary-digestive continuity was reestablished by hepaticoduodenostomy (HD) or hepaticojejunostomy (HJ). Results: From January 2007 to June 2011, 400 patients were operated on. There were 305 girls and 95 boys. Ages ranged from 1 month to 16 years (mean, 47.5 +/- 2.1 months). Cystic excision and HD were performed in 238 patients and HJ in 162 patients. The mean operating time was 164.8 +/- 51 minutes for the HD group and 220 +/- 60 minutes for the HJ group. Conversion to open surgery was required in 2 patients. There were no perioperative deaths. Postoperative biliary leakage occurred in 8 patients (2%), resolving spontaneously in 7 and requiring a second operation in 1 patient. The mean postoperative hospital stay was 6.4 +/- 0.3 days for the HD group and 6.7 +/- 0.5 days for the HJ group. Follow-up between 5 months and 57 months postdischarge (mean, 24.2 +/- 2.7 months) was obtained in 342 patients (85.5%). Cholangitis occurred in 5 patients (1.5%) in the HD group and 1 patient (0.6%) in the HJ group. Gastritis due to bilious reflux was 3.8% in the HD group. Conclusions: Laparoscopic repair is a safe and effective procedure for choledochal cyst. The rate of cholangitis and anastomotic stenosis is low.