I once contacted a mother whose baby was diagnosed with a common bile duct cyst in her prenatal tummy. I told her that this needed to be treated surgically, and that Professor Liu Juncheng of our hospital’s pediatric surgery department did a beautiful job with this surgery, and that I could help introduce her after the baby was born if needed. A few days later, she asked me if we do laparoscopic surgery here. Would it be better for her baby to have laparoscopic surgery? After I analyzed the advantages and disadvantages of laparoscopic and open surgery, I said, “We still do more open surgery on our side. Then there was no more. Later, I heard from someone that she finally chose to go to Beijing for laparoscopic surgery. Laparoscopic surgery has been advocated in the field of surgery for many years. Due to the advancement of technology, more and more complex surgeries that originally required open surgery can be replaced by laparoscopic surgery, and good results have been achieved. For example, laparoscopic partial hepatectomy, laparoscopic colectomy, and so on. Because laparoscopic surgery is less invasive and has a faster recovery, it is more acceptable to patients and their families than open surgery. If they are given a choice between the two, laparoscopic surgery will definitely win. So, is it really true, as one might think, that all laparoscopic procedures should be avoided? Obviously not. The current mainstream pediatric surgeons agree that laparoscopic surgery should not be recommended for biliary atresia Graciectomy. Why? Laparoscopic Gecey is technically feasible, but its efficacy is significantly worse than open Gecey. A retrospective study from the Department of Pediatric Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, also pointed out that laparoscopic surgery is one of the risk factors for poor prognosis of Geschi surgery. A prospective study comparing the outcomes of laparoscopic and open Geschi surgery from the Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, included 44 children undergoing laparoscopic Geschi and 47 children undergoing open surgery. The results showed that: laparoscopic surgery had less bleeding but longer operative time; there was no significant difference in postoperative hospital stay between the two; and there was no significant difference in postoperative regression rate, incidence of cholangitis, survival with autologous liver and recovery of liver function between the two. They concluded that laparoscopic surgery does not improve the prognosis of biliary atresia. The results of a recent meta-analysis that included 11 studies comparing the efficacy of laparoscopic and open Geschi surgery also suggest that laparoscopic Geschi cannot replace open surgery and that open Geschi remains the preferred method of treatment for biliary atresia. If you can’t read the above, you can stop reading. Anyway, just keep in mind that, at least for the time being, the clinical evidence is more in favor of open Graciectomy! As for the reasons, they may be as follows: the complexity of the Geschi operation itself, which requires a lot of training to become proficient; the limited operation and incomplete removal of the fibrous mass due to the small abdominal space in infants; etc. Some scholars even believe that even if the da Vinci robot is used to assist the surgery, it will not solve the above-mentioned shortcomings of laparoscopy in Geschi operation. Back to the example at the beginning of the article. You asked me if my mother’s choice was wise, and frankly, I can’t answer. After all, choledochal cyst is a much better procedure than biliary atresia in terms of prognosis, and there is almost no question of having to have a liver transplant after surgery. However, both are hepatobiliary procedures in pediatric surgery, and both have something in common. The disadvantages of laparoscopic surgery described above also apply in part to laparoscopic surgery for common bile duct cysts. As far as I know, one of the main points of choledochal cyst surgery is complete debridement of the cyst and ligation of the distal residual bile ducts to prevent pancreatic reflux, which in some cases is very difficult to achieve with an open abdomen. The reader should understand that I am not writing this article to deny laparoscopic Grosvenor surgery. After all, minimally invasive is the trend in surgery. Many large hospitals in China, including my hospital, Zhongshan First Hospital, have gone to great lengths to buy the da Vinci surgical robot, precisely to keep pace with the times. Perhaps, in the future, the development of technology, pediatric surgeons can overcome the current shortcomings, laparoscopic Gussy surgery can really replace open surgery, as we hope. But not yet. In fact, there are advantages and disadvantages to whatever type of treatment, no matter how advanced the technology. Responsible doctors will tell patients and families in detail the pros and cons of each treatment modality, and after that, those who are aggressive can choose to be aggressive, those who are conservative can choose to be conservative, and those who have money can choose to spend a lot of money. If you are selective and listen to high technology and think that doctors who do not treat you with advanced technology are old-fashioned, you may be the one who is disappointed.