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

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.