Single-incision laparoscopic hepaticojejunostomy for children with perforated choledochal cysts

Conventionally, perforated choledochal cyst (CDC) is a contraindication of laparoscopic treatment. The current study is to evaluate efficacy of single-incision laparoscopic hepaticojejunostomy (SILH) in children with perforated CDCs. One hundred and thirty-three children with perforated CDCs who underwent SILHs in our hospital between August 2011 and August 2017 were reviewed. Fifteen (11.3%) patients were converted to open procedures due to severe adhesions and oozing. The mean age at SILH was 2.09 years (range 2 days-12.37 years). The average operative time was 3.23 h (range 2-5 h). The mean postoperative hospital stay was 6.25 days (range 4-16 days). The mean time to full diet resumption was 2.18 days (range 2-6 days). The mean duration of drainage was 3.71 days (range 3-10 days). The median follow-up period was 24 months. Postoperative liver function tests and serum amylase levels returned to normal within 1 year. Three (2.5%) patients required blood transfusions because of extensive oozing from intramural micro-vessels of CDCs. Two (1.7%) patients encountered duodenal injuries because of severe adhesions. The duodenum was repaired with double-layer 5-0 PDS running sutures. One (0.8%) patient with giant CDC had abdominal fluids because of extensive dissection of intrapancreatic segment of CDC. He recovered after 10 days of drainage. None of patients had bile leak, anastomotic stenosis, cholangitis, intrahepatic reflux, pancreatic leak, pancreatic calculi formation, pancreatitis, Roux-loop obstruction, or adhesive intestinal obstruction. Single-incision laparoscopic hepaticojejunostomy is safe and effective for selected patients with perforated CDCs in experienced hands.