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. 2022 Nov;11(11):1831-1839.
doi: 10.21037/tp-22-557.

Modified single-port versus multiport laparoscopic choledochal cysts excision and Roux-en-Y hepaticojejunostomy: a retrospective comparative cohort study

Zhe Wang  1 , Xi-Si Guan  1 , Jia-Kang Yu  1 , Wei Zhong  1
Affiliations

Modified single-port versus multiport laparoscopic choledochal cysts excision and Roux-en-Y hepaticojejunostomy: a retrospective comparative cohort study

Zhe Wang et al. Transl Pediatr. 2022 Nov.

Abstract

Background: The feasibility, benefit, and safety of multiport laparoscopic choledochal cyst (CDC) excision and Roux-en-Y hepaticoenterostomy (MPCH) have been consistently confirmed. Single-port laparoscopic CDC excision and Roux-en-Y hepaticoenterostomy (SPCH) has advantages of less traumatic and more cosmetic beneficial, it has been reported in some case series, but it is technically challenging. We propose a modified technique to reduce technical difficulty in performing SPCH. The safety and feasibility of modified SPCH were compared with those of conventional multiport laparoscopic CDC excision.

Methods: A total of 43 consecutive patients who diagnosed with CDC by preoperative magnetic resonance cholangiopancreatography (MRCP) and underwent SPCH (n=24) and MPCH (n=19) for choledochal cyst (CDC) by a single surgeon between January 1, 2018, and January 1, 2021, were enrolled. The baseline clinical characteristics, efficacy and safety outcomes of short-term were compared.

Results: The baseline clinical characteristics of the MPCH and SPCH groups are comparable. Average postoperative length of hospital stay was shorter in the SPCH group than in the MPCH group, but the difference was not statistically significant (7.00 vs. 7.58 days; P>0.99). The operation time (281.75 vs. 277.3 min; P=0.58) and the amount of blood loss (9.33 vs. 16.68 mL; P=0.57) were similar in both groups. A significantly greater number of drainage tubes were placed in the MPCH group compared to the SPCH group (11 vs. 5; P=0.01). One patient suffered from hepaticoenterostomy anastomosis stricture in the SPCH group.

Conclusions: The short-term outcome of modified SPCH is comparable with MPCH according to our study. It is easily adaptable treatment of CDC.

Keywords: Roux-en-Y hepaticoenterostomy; Single-port laparoscopic surgery; choledochal cysts (CDCs); enhanced recovery after surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-22-557/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The trocar arrangement of MPCH. MPCH, multiport laparoscopic choledochal cyst excision and Roux-en-Y hepaticoenterostomy.
Figure 2
Figure 2
The umbilicus curve incision made at the skin fold in the SPCH procedures. (A) Incision design. (B) Incision appearance after the procedure. (C) Incision appearance 1 month after the procedure. SPCH, single-port laparoscopic choledochal cyst excision and Roux-en-Y hepaticoenterostomy.
Figure 3
Figure 3
The 3-operative-site (3–5 mm × 2, 5–10 mm × 1) 35-mm ellipse-shapes single port (Surgaid IIIA-3B-35 ×100) used for SPCH. SPCH, single-port laparoscopic choledochal cyst excision and Roux-en-Y hepaticoenterostomy.
Figure 4
Figure 4
Flow diagram of the patients identified, included, and excluded.
See this image and copyright information in PMC

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