A Study of Three-Dimensional Versus Two-Dimensional Laparoscopic Surgery in Resection of Congenital Choledochal Cyst of Children and Jejunum Roux-en-Y Anastomosis

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Background: This study aimed to explore the clinical efficacy of three-dimensional (3D) laparoscopic surgery in the treatment of congenital choledochal cysts (CCCs) by comparing it with two-dimensional (2D) laparoscopic surgery. Patients and Methods: We retrospectively reviewed data of 155 pediatric patients who underwent surgical treatment of choledochal cysts between January 2014 and December 2017. We divided the patients into two groups according to the surgical method used—a 3D laparoscopic group (N = 42) and a 2D laparoscopic group (N = 113). The 3D laparoscopic group was further divided into two subgroups based on age—Group 1 (age ≤12 months, N = 11) and Group 2 (age >12 months, N = 31). We analyzed data in terms of the following characteristics: patient demographics, perioperative and follow-up conditions, and complications. Moreover, we also recorded and analyzed the surgeon's assessment on laparoscopic system usage. Results: Cyst excision and Roux-en-Y hepaticojejunostomy (HJ) was successfully completed in all the patients. Intergroup differences in operating time and blood loss were statistically significant. There were no significant differences between the two groups in early and late complications, such as the incidence of wound infection, HJ stricture, or adhesive ileus. There were no significant differences in the operative data and outcomes between the two subgroups of patients who underwent 3D laparoscopic treatment. Based on surgeon's assessment, the 3D laparoscopic system had better depth perception and accuracy than the 2D laparoscopic system; however, there was no difference in the adverse effect on surgeons. Conclusions: Compared with the traditional 2D laparoscopic surgery, 3D laparoscopic surgical resection of CCCs combined with jejunum Roux-en-Y anastomosis is a safer and more effective procedure that can shorten operative time and reduce intraoperative bleeding with no increase in surgical strain. The 3D laparoscopic surgery technique may provide a better choice for CCC operations.

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