Comparative clinical study of laparoscopic and open surgery in children with choledochal cysts

Objectives: To investigate the safety and effectiveness of laparoscopic management of choledochal cysts compared with the open approach, even in early childhood. Methods: We conducted a retrospective study of 206 patients with choledochal cysts between June 2003 and May 2015. Of these, 104 patients underwent open cyst excision and hepaticojejunostomy (open operation [OP]) and 102 patients received laparoscopic management and hepaticojejunostomy (laparoscopic operation [LP]). The patients who underwent a laparoscopic approach were further divided by the age of 3 years. We compared patients' perioperative and follow-up conditions between the 2 approaches and the 2 age groups. Results: All patients were cured with no incidence of mortality. The operating time was significantly longer in the LP (OP: 225.4 +/- 51.0 min versus LP: 170.3 +/- 35.4 min, p=0.000), but blood loss (LP: 12.9 +/- 22.9 ml versus OP: 32.4 +/- 52.7 ml, p=0.001) was significantly larger in the OP. The number of days to normal oral feeding (LP: 3.3 +/- 0.9 dyas versus OP: 4.1 +/- 0.9 days, p=0.000) and postoperative stay-in-ward duration (LP: 7.5 +/- 2.7 days versus OP: 9.6 +/- 5.5 days, p=0.001) were significantly shorter with the LP. There were no significant differences among all of the above tests between the younger and older patients (p>0.05). Conclusions: Laparoscopic operation is safe and effective, even for young children. With the advantages of less blood loss, smaller trauma, shorter postoperative recovery time, and improved cosmetic features, it is worth considering its widespread application.