Hybrid Transumbilical Single Incision Versus Conventional Laparoscopic Surgery For Choledochal Cyst In Children

Objective:To compare the effect of hybrid transumbilical single incision and conventional laparoscopic surgery in the treatment of choledochal cyst in children.Methods:From 2017 to 2019,25 children with choledochal cyst underwent hybrid single incision laparoscopic choledochal cyst resection + Roux-en-Y hepaticojejunostomy(HSILH group),and 31 children with choledochal cyst underwent conventional laparoscopic choledochal cyst resection + Roux-en-Y hepaticojejunostomy(CLH group).We recorded and analyzed the perioperative parameters,duration of drainage and gastric tube,liver function,inflammatory indexes,and immunoglobulin levels to find their differences between the HSILH and CLH group.Results: No statistically significant differences were found in operation time [(206.3±33.0)min vs.(216.1±48.4)min],duration of abdominal drainage tube [(5.6±1.9)d vs.(6.1±2.9)d],postoperative hospital stay [(8.2±1.5)d vs.(9.3±3.0)d] between HSILH group and CLH group.The complication incidence was also comparable between the two groups.The flatus-passing time((1.5±0.6)d vs.1.9±0.7)d,P = 0.033)and duration of the gastric tube((3.9±0.8)d vs.(4.7±1.3)d,P = 0.008)were significantly decreased in the HSILH group than those in the CHL group.Liver function parameters were significantly decreased in both groups after surgery,such as bilirubin and liver enzymes.The postoperative leukocyte count(P = 0.025)and hypersensitive C-reactive protein(P = 0.012)in the HSILH group were significantly lower than those in CLH group.There was no significant difference in complement C3,C4,immunoglobulin IgG,IgA,and IgM between the HSILH group and CLH group.Conclusion:HSILH is safe and feasible procedure in the treatment of choledochal cyst with the advantage of minimally invasive surgery,cosmetic outcomes,and an acceptable incidence of perioperative complications.Compared with those receiving CLH,patients undergoing HSILH have a significantly reduced inflammatory response and improved recovery in gastrointestinal function.HSILH is a novel surgical approach for congenital choledochal cyst and should be generally performed in clinical practice.