Comparison of open and laparoscopic outcomes of adult Type-I congenital choledochal cysts

OBJECTIVE: To compare open and laparoscopic outcomes of adult Type-I congenital choledochal cysts. METHODS: Clinical data of 78 adult patients with Type-I congenital choledochal cysts, who had undergone cyst resection and Roux-en-Y hepaticojejunostomy in Chenzhou First People’s Hospital from September 1, 2021 to August 31, 2022, were retrospectively analyzed. Patients who received open approach and Roux-en-Y hepaticojejunostomy constituted the open group (n=35,) and patients who received laparoscopic approach and Roux-en-Y hepaticojejunostomy were assigned into the laparoscopic group (n=43,). The intraoperative and postoperative conditions, relevant laboratory indicators, and the rate of complications were compared between the two groups. RESULTS: Intraoperative blood loss, postoperative time to first flatus, diet recovery time, time to drainage tube removal, and length of hospitalization of the laparoscopic group were lower in the laparoscopic group compared to the open group (P<0.05). One day after the operation, serum amylase (SAMY) levels in both groups were significantly lower, while the levels of total bilirubin(TBIL), alanine aminotransferase(ALT), and C-reactive protein(CRP) were higher than before the operation. Postoperative SAMY level in the laparoscopic group was significantly higher, while the postoperative TBIL and CRP levels were significantly lower than those in the open group (P<0.05). The incidence of postoperative complications in the laparoscopy group (4.65%) was significantly lower than the open group (20.00%) (P<0.05). CONCLUSIONS: Laparoscopic cyst resection combined with Roux-en-Y hepaticojejunostomy is associated with lower extent of trauma, faster recovery, less inflammation, and fewer complications than open surgery in adult patients with Type-I congenital choledochal cysts.