Single-Incision Laparoscopic Repair for Iatrogenic Duodenal Injury in Children with Choledochal Cysts.

Background/Purpose: During laparoscopic excision of choledochal cysts (CDCs), if duodenum injury is encountered, conversion to open repair of duodenal injury is often the standard approach. This study evaluates if it is safe to repair the duodenal injury laparoscopically in CDC children. Materials and Methods: CDC children who underwent single-incision laparoscopic repair for iatrogenic duodenal injury between October 2013 and September 2018 were reviewed. According to the pathophysiology, duodenal injuries were categorized into two subtypes: Type 1: injury caused by severe adhesions between perforation site at distal CDC and the duodenum; Type 2: anatomical variation, that is, distal CDC shared the common wall with the duodenum. A transabdominal wall suture was placed through distal end of CDC. Relying on the adhesion between distal CDC and duodenum, the injured duodenum can be clearly exposed when the assistant pulled on the retraction suture. The duodenal injury was repaired by a two-layer 5-0 polydioxanone running suture. The distal CDC was transected after repair was accomplished. Results: Five children were reviewed (Type 1: n = 4, Type 2: n = 1). Median age at surgery was 1.2 years. Median operative time was 4.0 hours. Median postoperative hospital stay was 7 days. Median duration of full diet resumption and drainage were 5 days, respectively. Median follow-up period was 31 months. Liver function tests and serum amylase levels were normalized within 1 year. None of patients had intestinal leak, anastomotic stenosis, bile leak, cholangitis, pancreatic leak, pancreatitis, or adhesive intestinal obstruction. Conclusions: Single-incision laparoscopic repair for iatrogenic duodenal injury in CDC children is safe and effective.