Challenges and strategies for single-incision laparoscopic Roux-en-Y hepaticojejunostomy in managing giant choledochal cysts

• Giant choledochal cyst is challengeable for single-incision laparoscopic surgery.
• Cyst is punctured extracorporeally by angiocatheter and evacuated to create space.
• Retraction sutures are placed from proximal to distal cyst wall during dissection.
• Mean operative time is 3.18 h. No mortality or morbidities is observed.
• Single-incision laparoscopic hepatojejunostomy is safe for giant choledochal cyst.

Background/purposeGiant choledochal cyst (CDC) is thought to be a challenge for one-stage single-incision laparoscopic hepaticojejunostomy (SILH). We herewith designed the strategies for SILH in surgical management of giant CDC children, and reported its outcomes.MethodsTwenty-eight patients with giant CDCs successfully underwent SILH between April 2011 and October 2013. With guidance of an extra-long 5-mm 30° laparoscope, anterior cyst wall was punctured extra-corporeally using a 20-gauge angiocatheter. Cyst content was evacuated to create working space. A series of trans-abdominal retraction sutures were placed through serosa of gallbladder fundus, common hepatic duct and proximal to distal portion of anterior cyst wall to facilitate dissection. Cyst excision and hepaticojejunostomy was performed.ResultsMean age at operation was 6.24 months. Mean operative time was 3.18 h, significantly shorter than 6.3 h in our historical group undergone conventional laparoscopic hepaticojejunostomy. No blood transfusion was required. Post-operative recovery was comparable to that of our historical CLH controls. Median follow-up period was 24 months. No mortality or morbidities of anastomotic stenosis, bile leak, cholangitis or pancreatic leak was observed. Liver function normalized post-operatively.ConclusionsFollowing the strategy, SILH for giant CDCs is safe and one can achieve outcomes comparable to those of CLH in experience hands.