Hepatic Ductoplasty to Widen the Hepaticojejunostomy in the Single-Site Laparoscopic Resection of Choledochal Cyst in Children.

PURPOSE: To report our technique and outcomes of trans-umbilical laparoscopic single-site surgery (TULSS) with hepatic ductoplasty (HPD) to widen the hepaticojejunostomy (HJ) in the management of childhood choledochal cysts (ChC) with a small common hepatic duct (CHD).

METHODS

All ChC cases undergoing TULSS with HPD to widen the HJ at two centers from May 2013 to March 2023 were retrospectively reviewed. Our HPD technique was indicated for CHDs with a diameter of 5 mm or less. It consisted of a 4-6 mm longitudinal incision on the anterior duct wall at the 12 o'clock position; the suture line for the HJ was created transversely, resulting in a wider anastomosis. All HJs were performed using single-layer running 5-0 PDS sutures.

RESULTS

Fifty-six patients underwent HPD, with a median age of 25.5 months (range, 1-130 months). The mean diameter of the CHD before and after HPD was 4.3 mm (range, 2.5-5 mm) and 9.4 mm (range, 6-15 mm), respectively. The median operative time was 190 min (range, 150-280 min). There were no intraoperative complications, no conversions to open surgery, and no additional trocar placements. Postoperative bile leakage occurred in two patients (3.5 %) and resolved with conservative management. The median postoperative hospital stay was 5 days (range, 4-27 days). At a median follow-up of 86 months (range, 20-137 months), all patients were in good health without cholangitis, intrahepatic biliary dilatation, or stone formation.

CONCLUSIONS

The laparoscopic hepatic ductoplasty is a safe and effective option to widen the diameter of the hepaticojejunostomy in cases of choledochal cysts with a small hepatic duct.