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Minimally invasive strategy for type I choledochal cyst in adult: combination of laparoscopy and choledochoscopy

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Abstract

Background

Choledochal cyst (CC)is a rare disease entity, more commonly occurring in Asian populations. In case of no contraindication, CC is resected to avoid future malignancies and future complications.

Objective

To determine the optimal technique for treatment of patients with type I choledochal cyst by comparisons of indicators, including the duration of surgery, loss of blood, rates of complication, duration of hospitalization, and outcomes of long-term follow-up.

Methods

From January 2009 to September 2017, a combination of laparoscopy and choledochoscopy surgery was implemented for type I choledochal cyst in adult. Patients’ demographics data and treatment outcomes were collected prospectively during the follow-up.

Results

Fifty-eight patients with type I choledochal cyst were managed using this strategy. The combination of laparoscopic and intraoperative choledochoscopy was successfully performed in all patients without conversion or morbidity. When compared with a historical cohort of 71 patients who underwent a surgery for CC, this group of patients had significantly shorter duration of hospitalization (9.0 ± 6.5 days vs. 13.0 ± 8.0 days, P < 0.05). We also observed a lower blood loss (128.8 ± 60.2 mL vs. 178.1 ± 58.2 mL, P < 0.05), although the duration of the surgery (320.0 ± 50.0 min vs. 190.0 ± 24.5 min, P < 0.05) was longer. However, no significant difference was found in the rate of postoperative bleeding complication (3.45% vs. 4.23%, P = 0.82) and bile leakage complication (6.90% vs. 4.23%, P = 0.51). The two groups had similar rates of anastomotic stenosis (0.96% vs. 0.61%%, P = 0.47), jaundice (0.58% vs. 0.61%, P = 0.95), cholangitis (0.38% vs. 0.30%, P = 0.81), and reoperation (0.38% vs. 0.15%, P = 0.43).

Conclusion

The type I choledochal cyst in adult can be effectively managed by laparoscopic surgery combined with inoperative choledochoscopy, which is feasible and minimally invasive. With the development of laparoscopic techniques and instruments, laparoscopic surgery may become the first-choice treatment for type I choledochal cyst treatment.

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Authors and Affiliations

  1. Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Nankai District, No. 122, San Wei Road, Tianjin, 300100, China

    Haicheng Yuan, Guoqiang Dong, Xiangyu Sun & Hongzhi Zhao

  2. Department of Gastrointestinal Surgery, Tianjin Nankai Hospital, Tianjin, China

    Nan Zhang

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  1. Haicheng Yuan
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  2. Guoqiang Dong
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  3. Nan Zhang
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  4. Xiangyu Sun
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  5. Hongzhi Zhao
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Contributions

HCY, NZ, XYS, HZZ, and GQD contributed to the conception and the design of this study. HCY and GQD collected, analyzed, and interpreted the data. HCY and GQD drafted the manuscript, and HCY and HZZ critically revised the manuscript. All authors agree to be fully accountable for having ensured the integrity and accuracy of the work, and have read and approved the final version of the manuscript.

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Correspondence to Haicheng Yuan.

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Haicheng Yuan, Guoqiang Dong, Nan Zhang, Xiangyu Sun, and Hongzhi Zhao have no conflicts of interest or financial ties to disclose.

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Yuan, H., Dong, G., Zhang, N. et al. Minimally invasive strategy for type I choledochal cyst in adult: combination of laparoscopy and choledochoscopy. Surg Endosc 35, 1093–1100 (2021). https://doi.org/10.1007/s00464-020-07473-z

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  • DOI: https://doi.org/10.1007/s00464-020-07473-z

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