Trans-Umbilical Laparo-Endoscopic Single Site Surgery with Hepatic Ductoplasty in Management of Childhood Choledochal Cyst: A Single Surgeon Experience with 46 Cases

Aim: To present our techniques and results of trans-umbilical laparo-endoscopic single site surgery (TULESS) with hepatic ductoplasty in the management of childhood choledochal cyst (ChC). Methods: All ChC cases undergoing TULESS excision of ChC, ductoplasty and hepatico-jejunostomy by the same surgeon from October 2012 to October 2017 were reviewed. For TULESS, 3 trocars were placed at a single umbilical skin incision and conventional instruments were used. Results: 46 patients (35 girls, 11 boys) with hepatic ductoplasty were identified from total 237 patients with ChC undergoing TULESS by the same surgeon for the review period. The median age was 17 months. Ductoplasty for a small common hepatic duct (less than 5mm) was carried out in 38 patients and for the presence of an aberrant duct in 8 patients. The median operative time was 195 minutes. There was no intraoperative complication, no conversion to open surgery. Additional trocars (conversion to conventional laparoscopic surgery) were required in just the first case of aberrant duct. Postoperative bile leak was noted in one patient (2.2%), which was resolved with non-operative treatment. The median postoperative hospital stay was 5 days. At a median follow up of 36 months (range: 3 months to 60 months), one patient needed redo surgery for anastomotic stenosis; all other patients were in good health, with excellent postoperative cosmesis. Conclusion: TULESS with conventional instruments is feasible and safe for hepatic ductoplasty for childhood ChC with small common hepatic duct or aberrant duct. Patient’s characteristics, intraoperative findings, operative time and results were analyzed.