Transumbilical Laparoendoscopic Single-Site Surgery with Conventional Instruments for Choledochal Cyst in Children: Early Results of 86 Cases

Abstract

Abstract

Introduction:

The aim of this study is to present our techniques and early results of transumbilical laparoendoscopic single-site surgery (TULESS) for childhood choledochal cyst (ChC).

Materials and Methods:

Medical records of all children undergoing TULESS for ChC at our center from September 2012 to December 2013 were reviewed. Our TULESS operations started with a Z-shaped umbilical skin incision and placement of three 3–5-mm ports at separate points in the same incision site. The Roux-en-Y loop was created extracorporeally through the umbilical incision. Excision of the ChC and hepaticointestinal anastomosis were performed using conventional laparoscopic instruments.

Results:

Eighty-six patients were identified with a median age of 24.5 months. The ChC was successfully excised by TULESS in all cases. Hepaticojejunostomy was performed in 84 cases, versus hepaticoduodenostomy in 2 cases. Additional trocars were needed in just 1.2%. There was no conversion to open surgery. The median operative time was 195 minutes. No drain was used in 90.7% of cases. There was no anastomotic leakage. Mild umbilical infection was noted in 2.3%. The median postoperative hospital stay was 5 days. At follow-up of 4–18 months, 1 patient needed a redo surgery for anastomotic stenosis; all other patients were in good health. The postoperative cosmesis was excellent as all TULESS patients were virtually scarless.

Conclusions:

TULESS with conventional laparoscopic instruments for ChC in children is feasible, with excellent postoperative cosmesis. The early outcome is promising, and TULESS can be a viable option for scarless surgical management of childhood ChC at experienced centers.