Improvement and development direction of bariatric metabolic surgery / 中华消化外科杂志

In more than half a century of the development of bariatric metabolic surgery, a variety of classic surgical methods have been formulated. However, the improvement and innovation of bariatric metabolic surgery has never stopped. The replacement of new and old surgical methods in clinical application and development reflects the vitality and progress in the field of bariatric metabolic surgery, and also promotes the development of bariatric metabolic surgery to the best balance between benefits and risks. In the early stages, studies in metabolic surgery are more inclined to confirm the efficacy, safety and mechanism of classical procedures. In recent years, metabolic surgeons around the world have become more inclined to focus on the exploration and innovation of new procedures. In addition, the improvement of biliopancreatic diversion with duodenal switch and the sleeve gastrectomy plus procedures have gradually become hot spots for surgical innovation. However, the new techniques are diverse, scattered and partially overlapping. The authors make a comment on this content, in order to provide assistance to clinical and scientific research.

Opportunities and challenges of bariatric and metabolic surgery in the future / 国际外科学杂志

Bariatric and metabolic surgery has been in China for more than 30 years, which has developed rapidly. However, it can be predicted that there will be many opportunities and challenges in the future development of bariatric and metabolic surgery, including the replacement of classic surgical methods, the guarantee of surgical safety, the brave exploration of new surgical methods, the decisive abandonment of bad surgical methods, the implementation of surgical standardization, and the breakthrough of basic and clinical research all mean more efforts. With the continuous rise of the incidence rate of metabolic syndrome and the continuous improvement of people′s health needs, these opportunities and challenges are particularly significant. Bariatric and metabolic surgery will also play a crucial role in overcoming obesity and metabolic diseases.

The influence of new surgical methods on the development of bariatric and metabolic surgery / 中华消化外科杂志

Bariatric and metabolic surgery originated in the 1950s. After continuous verifications and improvements by bariatric and metabolic surgeons all over the world, bariatric surgery has been recognized as the 'gold standard’ for the treatment of metabolic diseases such as obesity. In the development of more than half a century, bariatric and metabolic surgery have formed a variety of classic surgical methods. At the same time, the new methods of bariatric surgery are emerging. Among them, the additional surgery based on sleeve gastrectomy has become a research hotspot. In the process of clinical applications of various new bariatric surgery methods, bariatric and metabolic surgeons should be objective, accurate, realistic, and move forward on the basis of criticizing and absorbing. The authors investigate the influence of new surgical methods on the development of bariatric and metabolic surgery.

Retrospect of twenty years of development and prospect of bariatric and metabolic surgery in China / 中华消化外科杂志

Nowadays, the incidence of obesity and related metabolic diseases is increasing around the world, which seriously endangers the human health and the quality of life. Obesity has become the most prominent public health issue in the time. With the rapid development of surgical treatment of obesity combined with type 2 diabetes mellitus, bariatric surgery has gradually evolved into a new important branch of upper gastrointestinal surgery or gastrointestinal surgery, that is bariatric and metabolic surgery. To date, bariatric surgery has entered in China since twenty years ago. Following the steps of the rapid development of bariatric and metabolic surgery in the world, bariatric surgery has embarked on a solid and steady journey of development through seizing the opportunity, finding the right direction. On the way forward in the past twenty years, Chinese bariatric and metabolic surgery has not only faced setbacks and confusion, but also gained experience and lessons; it has encountered bottlenecks in its development and provided evidences from China. The number of surgeons in bariatric surgery is still limited compared with a large number of obese people. Therefore, there will be opportunities and challenges coexisting in the future. How to continuously improve the therapeutic effect of surgery, train more professional practitioners, break through the bottleneck, and seek faster development will be an important research topic in metabolic and bariatric surgery with the scientific evidence-based medicine accumulating.

Retrospect of twenty years of development and prospect of bariatric and metabolic surgery in China / 中华消化外科杂志

Nowadays,the incidence of obesity and related metabolic diseases is increasing around the world,which seriously endangers the human health and the quality of life.Obesity has become the most prominent public health issue in the time.With the rapid development of surgical treatment of obesity combined with type 2 diabetes mellitus,bariatric surgery has gradually evolved into a new important branch of upper gastrointestinal surgery or gastrointestinal surgery,that is bariatric and metabolic surgery.To date,bariatric surgery has entered in China since twenty years ago.Following the steps of the rapid development of bariatric and metabolic surgery in the world,bariatric surgery has embarked on a solid and steady journey of development through seizing the opportunity,finding the right direction.On the way forward in the past twenty years,Chinese bariatric and metabolic surgery has not only faced setbacks and confusion,but also gained experience and lessons;it has encountered bottlenecks in its development and provided evidences from China.The number of surgeons in bariatric surgery is still limited compared with a large number of obese people.Therefore,there will be opportunities and challenges coexisting in the future.How to continuously improve the therapeutic effect of surgery,train more professional practitioners,break through the bottleneck,and seek faster development will be an important research topic in metabolic and bariatric surgery with the scientific evidence-based medicine accumulating.

Current status and analysis of metabolic and bariatric surgery in China / 中华内分泌外科杂志

With the rapid development of economy,obesity and type 2 diabetes have become serious social problems in china.Due to continued advances in the treatment of diabetes and the development of bariatric surgery,the efficacy of this approach has been recognized by more and more physicians.Bariatric surgery has clear effects on body weight,glycemic control,and diabetes-related complications.The field of bariatric surgery in China is always developing and improving.In this paper,we will review the current status of the concept of bariatric surgery in China,analyze the number of bariatric surgery,evaluate the efficacy of bariatric surgery,surgical procedures,and training in bariatric surgery,and analyze quality control situation in order to promote the development of bariatric surgery in china.

Current status and changes of metabolic and bariatric surgery in China / 中华胃肠外科杂志

Through continuous development, metabolic and bariatric surgery (MBS) has become widely recognized in academic and medical circles. In China, the volume of MBS operations has increased year by year. Therapeutic goals of MBS have evolved from treating obesity to treating Type 2 diabetes mellitus, and further to treating a series of obesity-associated metabolic diseases (including conditions in the endocrine system, circulatory system, respiratory system, reproductive system, and etc). Surgical approach of MBS has also been evolving continuously. Currently the common surgical procedures include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB) and bilio-pancreatic diversion with duodenal switch (BPD-DS). All surgical procedures have pros and cons, and the choice of surgical procedures should be based on the conditions of patients, the surgeon's technical ability, and benefits and operative risks. With the development of MBS, the proportions of different surgical procedures also changed in China. In recent five years, the proportion of AGB has decreased continuously and LAGB is no longer a common procedure. The proportion of LSG has increased rapidly, rising from 9% in 2010 to 55% in 2015. The proportion of RYGB has increased from 57% to 64% between 2010 and 2013, and remained at 45% afterwards. Since 2010, most MBS operations are laparoscopic surgery. 3D Laparoscopic surgery, laparoendoscopic single-site surgery and da Vinci Robotic Surgery have also been introduced in MBS. This review discusses the status quo and changes of MBS in china, as well as the new technology in MBS, aiming to strengthen the information and comprehension of MBS in china.

Transformation of bariatric and metabolic surgery principles / 中华消化外科杂志

Obesity-induced insulin resistance and metabolic syndrome continue to pose an important public health challenge worldwide.Metabolic surgery was developed with the aim of weight reduction.In recent years,authors have witnessed great advancement in metabolic surgery,including the development of new and safe procedures or devices.During the last decade,improvements in glycemic control and decreases in cardiovascular events and mortality after surgery have been consistently reported.Therefore,there is an urgent need to identify the type of patients that may benefit the most from metabolic surgery,morbidly obese or not,and selection criteria must be reviewed and updated based on the current surgical outcomes.This article reviews the history of metabolic surgery and summarizes the new perceptions in obesity treatment.

Application of three-dimensional laparoscope in metabolic and bariatric surgery / 中华消化外科杂志

With the rapid development of minimally invasive techniques,the emergence of three-dimensional (3D) laparoscope leading minimally invasive surgical accessPrecise Time.In the past 60 years,bariatric surgery provides a large number of clinical evidences to confirm:metabolic and bariatric surgery is lasting and effective for obesity combined with type 2 diabetes mellitus (T2DM),and it is also the best treatment method for T2DM.The author believes that 3D laparoscopic system can help beginners quickly master laparoscopic surgical techniques and shorten the learning curve to master the technical points.Compared with two-dimensional (2D) laparoscopic surgery,3D laparoscopic stereo vision can help experienced bariatric surgeons shorten operation time which is related to surgical procedures.The shorter surgical procedure in laparoscopic sleeve gastrectomy is hardly affecting the operation time.Because gastric bypass surgery is relatively complex,3D laparoscopic techniques which are fully utilized in gastric bypass surgery can effectively shorten the operation time.

DTI and DTT in evaluation of effect of childbearing history on female pelvic floor muscles / 实用医学杂志

Objective To investigates the feasibility of diffusion tensor imaging (DTI) and diffusion tensor tracking (DTT) for evaluation of the effect of childbearing history on female pelvic floor muscles. Methods Forty-six healthy females were divided into two groups: nulliparous and primiparous. MR conventional sequences and DTI were acquired. The optimized FA threshold value was obtained by regulating the FA to fiber tracking. The two groups were compared in terms of ADC, FA, VRA and T2-WT. Results (1)The DTT of FA 0.18 got the highest score in fiber tracking . ( 2 ) The ADC of nulliparous subjects and the subjects who had given birth were (1.24 ± 0.11) ×10-3 mm2/s, (1.33 ± 0.11) ×10-3 mm2/s (P = 0.017). There were no statistical differences in FA, VRA and T2-WT between the two groups (P > 0.05). Conclusions The optimized FA threshold of fiber tracking in pelvic floor muscles is 0.18. DTI and DTT may be used to evaluate the effect of childbearing history on female pelvic floor muscles.

New mechanisms and updates of bariatric and metabolic disease surgeries / 中华消化外科杂志

In recent decades, human lifestyle has undergone tremendous changes with the development of society,obesity, type 2 diabetes mellitus and related metabolic diseases have been prevalent around the world.In addition to the traditional treatment including diet control, lifestyle modification and drug intervention, bariatric and metabolic disease surgeries have become the significant therapeutic means.In recent years, the international community has made some breakthroughs in the mechanisms of surgical treatment for obesity and metabolic disease, the mechanism that gastrointestinal surgery activates the body to increase energy expenditure and white adipose tissues convert to brown become the new hot spot.In western countries,bariatric surgery has already undergone semicentennial renewal and evolution.Currently, classical metabolic surgery methods basically reach a consensus worldwide, however, along with the changes of the surgery methods, patients who accept early surgical treatments of obesity and metabolic disease or who are not satisfied with the initial surgery can be further remedied through repairing operation.In addition, the rapid development of endoscopic technique provides a new idea for renewal of bariatric surgery.This review focuses on the latest international developments about the mechanisms of metabolic disease surgery and the innovation of operation methods.

Experimental investigates on changes of expression of Aquaporin2 (AQP2) in renal of rats with obstructive jaundice / 中国免疫学杂志

Objective:To investigate the change of expression of AQP 2 in renal of obstructive jaundice rats , and the relationship between AQP 2 and the changing of Cr and BUN.Methods: Legated the common bile duct of rats to form the obstructive jaundice group.Scarified the rats on the 3th,5th,7th,10th,14th day,took blood samples and the kidney of the rats.Test direct bilirubin BUN and Cr in serum,the renal histopathological changes were observed by optical microscopy .The expression of AQP2 in renal of rats was tested by using radio immunological method.Results: Light microscopic examination of kidney showed that swelling epithelium arranged irregularly in 3rd day ,bleb in the 5th day.The expression of AQP2 in renal of rats with obstructive jaundice were greatly less than sham operation.Mesenchyma inflammatory cells infiltrate in 7th day.Local epithelial necrosis and lots of inflammatory cells infiltrate in the mesenchyma in 10th day and 14th day.The expression of AQP2 in renal collective tubule was decreased on the 5th day compared with sham operation ,and the decrease was more as time gone by.The renal function injury can be confirmed though the renal collective tubule change.Cr and BUN in serum began to increase on the 10th day and 14th day.Conclusion: Decrease of AQP2 is earlier than the increase of Cr and BUN ,and it can be the early sign of renal function injury.

Status and future of metabolic surgery in China / 中华消化外科杂志

With the rapid development of China's economy,obesity and diabetes have become a serious social problem.Metabolic surgery has grown mature abroad,while it started relatively late in China.There is obvious lack of operative indications,mode and procedure,preventions of complications,perioperative management and follow-up in the early time.To standardize nationwide surgical treatment of diabetes,to make the treatment of type 2 diabetes mellitus (T2DM) patients with the best way,to reduce the incidence of postoperative complications,the domestic famous experts assembled by the Branch of Obesity and Diabetes Surgeons Committee of the Chinese Medical Doctor Association composed the Surgical Treatment Guidance of Obesity and Type 2 Diabetes in China (2014).Metabolic surgery rapidly be popularized across the country.The number of surgery is rising year by year,especially making further standardization of operative indications and modes.Many academic meetings are conveyed to promote the discipline to develop,and provide the communication platform for metabolic surgeons.The future development of metabolic surgery will be accompanied by technological progress,equipment updates,operation excellence and continuous improvement.

Clinical characteristics and prognostic factors of primary duodenal carcinoma / 中华消化外科杂志

Objective To summarize the clinical characteristics and investigate the prognostic factors of primary duodenal carcinoma.Methods The clinical data of 122 patients with primary duodenal carcinoma who were admitted to the Shengjing Hospital Affiliated to China Medical University from November 2007 to May 2013 were retrospectively analyzed.All the patients received different operations according to the characteristics of tumors.Primary duodenal carcinomas of patients were confirmed by the postoperative pathological diagnosis.All the patients were followed up by outpatient examination, telephone interview and correspondence till November 30,2014.The treatment process, results of imaging examination and laboratory examination and postoperative survival were recorded.The clinical features, diagnostic criteria, therapeutic regimens and prognostic factors were analyzed.The survival rate and survival curve were analyzed and drawn by the Kaplan-Meier method.The univariate analysis was done using the Log-rank test, and multivariate analysis was done using the COX regression model.Results Among the 122 patients with primary duodenal carcinoma, jaundice as the first symptom was detected in 57 patients, abdominal pain and upper abdomen discomfort in 37 patients, gastrointestinal obstruction in 14 patients,anorexia and reduction of body weight in 4 patients, gastrointestinal hemorrhage in 3 patients, diarrhea in 3 patients, pyrexia in 3 patients and abdominal mass in 1 patient.The positive rates of CT examinations, endoscopic examinations, magnetic resonanced cholangio-pancreatography (MRCP), B-ultrasound examinations and upper gastrointestinal contrast examinations were 69.67％ (85/122), 85.56％ (77/90), 79.76％ (67/84), 12.73％ (7/55) and 75.00％ (36/48), respectively.Among the 122 patients, anemia was detected in 48 patients,positive fecal occult blood test in 94 patients, increasing level of CA19-9 in 71 patients, increasing level of CEA in 22 patients and increasing level of AFP in 9 patients.The tumors located at the descending part of duodenum,duodenal bulb and horizontal part of duodenum were detected in patients of 86.07％ (105/122), 7.37 ％ (9/122) and 6.56％ (8/122), respectively.The mean diameter of tumors was 2.3 cm (range, 1.0-15.0cm).All the 122 patients received operation.Pancreaticoduo-denectomy was performed in 100 patients, including combined with jejunostomy in 17 patients, pylorus-preserving pancreatoduodenectomy in 7 patients, segmental resection of duodenum and gastrojejunostomy in 5 patients, local resection of duodenal papilla in 6 patients and palliative gastrojejunostomy in 11 patients.Nineteen patients with complications were cured by symptomatic treatment.Of the 122 patients, adenocarcinoma, carcinoid tumor, lymphoma, small cell carcinoma, intraepithelial neoplasm combined with differentiated rhabdomyoma and with undifferentiated rhabdomyoma were detected in 116, 2, 1, 1,1 and 1 patients, respectively.The Ⅰ , Ⅱ , Ⅲ and Ⅳ stage of tumors were detected in 10, 4, 74 and 34 patients.There were 100 patients without lymph node metastasis, 13 patients with 0 ＜ metastatic lymph node ratio (MLR) ≤0.2, 4 patients with 0.2 ＜ MLR≤0.4 and 5 patients with MLR ＞ 0.4.One-hundred and twelve of 122 patients were followed up for 1-70 months with a median follow-up time of 20 months.The postoperative survival time, a median of survival time, postoperative 3-and 5-year survival rates were 1-70 months, 18 months, 36.6％ and 13.5％ , respectively.The results of univariate analysis showed that the lymph node metastasis, differentiated grade of tumor, MLR and with invasion of pancreas were risk factors affecting the prognosis of patients (x2 =8.465, 57.355, 16.232, 20.112, P ＜ 0.05).The multivariate analysis showed that the low-differentiation of tumor, invasion of pancreas, lymph node metastasis and MLR ＞ 0.4 were independent risk factors affecting the prognosis of patients (RR =3.330, 3.718, 2.623, 95％ confidence interval: 1.861-5.956, 1.292-10.696,1.624-4.236, P ＜ 0.05).Conclusions Most of the primary duodenal carcinomas are located at the descending part of duodenum without specific clinical symptoms in the early stage.The joint usage of assistant examinations can improve the diagnostic rate of primary duodenal carcinoma, and surgery is mainly therapeutic method.The low-differentiation of tumor, MLR ＞ 0.4 and invasion of pancreas are independent risk factors affecting the prognosis of patients.

Application of revisional operation in failure and complication of bariatric surgery / 中华胃肠外科杂志

For the vast majority of morbidly obese patients, surgical treatment remains the only effective way proven to maintain weight loss. Currently adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass(RYGB) are the methods which are recognized as safe, reliable, effective for weight loss, and has been widely used. Along with the increase in the volume of bariatric operations, patients whose primary bariatric operation is not ideal and who need revision surgery are also increasing. Weight loss failure and postoperative complications are two of the main indications for revisional operation. A series of data indicate that revisional operation is an effective treatment for unsuccessful weight loss and complications of primary operation. Surgeons should choose reasonable, correct operation refer to the initial bariatric operation and results. For most patients, the benefits overweigh the risks.

The mechanism of improving insulin resistance of skeletal muscles by ghrelin / 中华内分泌外科杂志

Objective To investigate the effects of acyl and deacyl ghrelin on the expressions of PI3Kp85α,Akt/PKB and GLUT4,the key factors in insulin receptor signaling pathway of insulin resistance in skeletal muscle cells.Methods Insulin resistance models were made by palmitic acid induced rat L6 myoblasts.Successful models were divided into acyl ghrelin group,deacyl ghrelin group,PI3K inhibitor(LY) + acyl ghrelin group,LY + deacyl ghrelin group and control group with corresponding interventions for 24h.The glucose uptake of all group was measured through laser confocal microscopy and flow cytometry.Expressions of phosphorated/total PI3Kp85α,phosphorated/total Akt and cell membrane/total GLUT4 of skeletal muscle cells were measured by Western blot,and PI3Kp85α,Akt,GLUT4 mRNA expression were detected by real-time PCR.Results Induced L6 myoblasts differentiation and insulin resistance model were successfully established.Acyl and deacyl ghrelin could increase glucose uptake for 1.25 and 1.28 folds compared to control group,and the phosphorated and total PI3Kp85α expressions were 1.78 and 1.89 folds to control group,and phosphorylated/total Akt and cell membrane/total GLUT4 were 1.84 and 1.80 folds to control group.The PI3Kp85α,Akt/PKB and GLUT4 mRNA expression were also upregulated compared to control group.The above indexes of LY + acyl or deacyl ghrelin group decreased significantly compared to acyl and deacyl ghrelin group without LY.Conclusions Acyl and deacyl ghrelin can both improve insulin resistance in skeletal muscle cells,increasing the glucose uptake under insulin-stimulation,and up-regulated the phosphorated PI3Kp85α,phosphorated Akt/PKB,and cell membrane GLUT4 relative protein expressions and mRNA expressions.PI3K inhibitor,LY294002,can inhibit the above improvement effect of acyl and decyl ghrelin.

Standardization and promotion of surgical treatment for obesity and type 2 diabetes mellitus / 中华消化外科杂志

The curative effect of surgical treatment for obesity and type 2 diabetes mellitus has been internationally recognized.In mainland China,the number of the minimally invasive gastric volume reduction surgery has been increased from 110 cases in 2008 to 2000 cases in 2012.While some of the patients suffered from poor curative effects or severe postoperative complications due to lack of unified standard treatment guidelines.Authoritative statistical agencies and the Chinese clinical database has not been formed till now,therefore the specification and promotion of Chinese surgical treatment standards for obesity and type 2 diabetes mellitus is imperative.

Acylated ghrelin and unacylated ghrelin inhibit INS-1 pancreas β-cell injury induced by sustained high glucose / 中华内分泌代谢杂志

Objective To examine whether ghrelin has beneficial effect on survival of pancreatic INS-1 beta cell.Methods Rat INS-1 cells were cultured separately in 5.6 mmol/L glucose (NG group),33.3 mmol/L glucose (HG group),33.3 mmol/L glucose plus 10 nmol/L acylated ghrelin (HG+AG group),and 33.3 mmol/L glucose plus 10 μmol/L unacylated ghrelin(HG+UG group).After being incubated for different hours,cell suvival rate was determined by MTT.Activity of caspase-3 was estimated by spectrophotometry,activity of GRP78,and cytochrome c was analyzed by confocal microscopy.Results Both acylated ghrelin and unacylated ghrelin inhibited the rise in activity of GRP78,caspase-3,and cytochrome c induced by sustained high glucose.Conclusions These findings indicate that ghrelin is able to inhibit endoplasmic reticulum stress and mitochondrial dysfunction of INS-1 β-cell caused by persistent high glucose,and the effect of ghrelin is not affected by acylation.

Efficacy of laparoscopic sleeve gastrectomy for the treatment of morbid obesity: a 5-year study / 中华消化外科杂志

Objective To investigate the 5-year efficacy of laparoscopic sleeve gastrectomy for the treatment of morbid obesity.Methods The clinical data of 31 patients with severe morbid obesity and related complications who were admitted to the Shengjing Hospital of Chinese Medical University from January 2006 to December 2007 were retrospectively analyzed.The 31 patients received laparoscopic sleeve gastrectomy and were followed up for 5 years to observe the perioperative condition,incidence of long-term complications,application of hypoglycemic drug and insulin before and after operation,the body mass index (BMI) was detected 6 months,1,2,3,4,5 years after operation,and the decrease of excess weight loss (EWL) was analyzed.The remission rate of complications,incidence of complications and the patient satisfaction score were recorded.The count data were analyzed using the chi-square test or Fisher exact probability.Repeated measurement data were analyzed using the repeated measure ANOVA,a Greenhouse-Geisser adjustment was used to correct serial dependency.Results Twenty-five patients were followed up for 5 years postoperatively.Of the 25 patients,4 (16.0％) had gastroesophageal reflux disease,and were cured by medical treatment; 1 patient (4％) had anastomotic stenosis; the percentage of EWL of 2 patients (8.0％) was under 60％ ; 4 patients (16.0％) had occasional obdominal pain.The percentage of patients with diabetes mellitus was decreased from preoperative 9.7％ (3/31) to postoperative 4.0％ (1/25),with a significant difference (P ＜ 0.05).The percentage of patients with fatty liver was decreased from preoperative 93.5％ (29/31) to postoperative 32.0％(8/25),with significant difference (x2=19.10,P ＜ 0.05).The percentage of patients with hyperlipidemia was decreased from preoperative 77.4％ (24/31) to postoperative 12.0％ (3/25),with significant difference (x2 =35.51,P ＜ 0.05).The level of BMI was decreased from preoperative (38.8 ±4.2) kg/m2 to postoperative (28.5 ± 3.1) kg/m2,with significant difference (F =113.36,P ＜ 0.05).The percentage of EWL was increased from preoperative 42％ ± 11％ to postoperative 69％ ± 16％,with significant difference (F =41.71,P ＜0.05).There was no significant difference in the patient satisfaction score between each year within the 5 years (F =0.92,P ＞ 0.05).Conclusions Laparoscopic sleeve gastrectomy is effective in losing weight with few long-term complications.

Laparoscopic surgery for adult congenital choledochal cyst / 中华肝胆外科杂志

ObjectiveTo study the feasibility,safety and efficacy of laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for adult congenital choledochal cyst.MethodA retrospective study was conducted on 7 adult patients with congenital choledochal cyst who received total laparoscopic cyst excision and Roux-en-y hepaticojejunostomy from May 2008 to February 2011 in the Department of General Surgery of Shengjing Hospital,China Medical University.ResultsAll the laparoscopic surgery was successful.The mean operation time was 210 minutes.The average intraoperative blood loss was 80 ml.All patients were out of bed within the first 24 h after surgery.The mean time to first flatus/bowel motion was 2.4 days.Except 1 patient who had small amount of bile leakage,all patients recovered smoothly without any major postoperative complications.The average hospital stay was 8.1 days.No patients suffered from abdominal pain,fever or jaundice during follow-up from 3 to 30 months.ConclusionTotal laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy was a safe,efficacious,and minimally invasive procedure.