Single-Port Laparoscopic Choledochal Cyst Radical Surgery Using Mucosal Eversion Technique in Small-Diameter Hepaticojejunostomy.

Abstract

Background: Single-port laparoscopic choledochal cyst (CDC) excision and Roux-en-Y hepaticoenterostomy (SPCH) exhibits several advantages over conventional laparoscopic techniques in the management of CDCs. However, performing small-diameter hepaticojejunostomy during single-port laparoscopy presents significant challenges, thereby increasing the risk of anastomotic complications. In this study, we employed the mucosal eversion (ME) technique to alleviate the difficulties associated with executing small-diameter hepaticojejunostomy during SPCH and report the preliminary outcome of a prospective case cohort. Methods: Patients diagnosed with CDC and found common hepatic duct diameter was smaller than 5 mm during SPCH were included. ME was performed on these patients. Clinical information, Magnetic resonance imaging image data, and surgical information data were collected, and patients were followed up for at least 1 year to assess surgical outcomes and postoperative complications. Results: A consecutive cohort of 16 patients was included from August 2020 to July 2023. All 16 patients successfully underwent ME during SPCH. The median age at surgery was 14.25 months, with an average hepaticojejunostomy diameter of 6.75 mm (ranging from 5 to 8 mm). The mean operation time was 266.25 minutes, and the average posthospital stay was 6.31 days (ranging from 4 to 9 days). During a follow-up period of 12-47 months, no cases of anastomotic leakage or stenosis were observed in this cohort. Conclusions: The ME technique is easy to execute and outcomes are reliable. It constitutes an efficacious approach to enhancing the prognosis of small-diameter biliary-enteric anastomosis in patients with CDCs undergoing SPCH.