Preliminary Experience with Continuous Submucosal Anastomosis in Small-Diameter Hepaticojejunostomy during Single-Port Laparoscopic Choledochal Cyst Surgery in Children

Abstract

Purpose: Hepaticojejunostomy anastomosisis(HJA) the most challenging aspect in single-port laparoscopic choledochal cystectomy and Roux-en-Y hepaticojejunostomy(SPCH) in children, especially in small-diameter anastomoses (diameters less than 5 mm), which are more susceptible to anastomotic stricture. We developed the continuous submucosal technique for hepaticojejunostomy (CS-HJA) to lessen postoperative complications. The purpose of this study is to introduce our preliminary experiences with CS-HJA Methods: We retrospectively analyzed all available clinical data of children who underwent SPCH surgery between March 2020 and October 2022. We operated with CS-HJA on 10 children who were diagnosed with small diameters hepaticojejunostomy(diameter is less than 5mm) .Data collection mainly included demographic information, imaging data, perioperative details, and postoperative outcomes. Ten patients were included in this study.The average patient age was 55.2 months and the age range was 3 months to 120 months and the average weight was 11.6 kg, male-female ratio was 1:9.The choledocho had fusiform dilatation in 5 cases and cystic dilatation in 5 cases, There was no dilatation of the left and right hepatic ducts or intrahepatic bile ducts in all patients .All patients had no dilatation of the left and right hepatic ducts or intrahepatic bile ducts.All patients underwent a single-port laparoscopic bile-intestinal anastomosis using a sub-mucosal jejunal anastomosis technique.Analysis of the duration of the bile-intestinal anastomosis, the length of the child's stay in the hospital after surgery, the intraoperative complications, and the postoperative complications. Results: All the 10 patients underwent successful SPCH by CS-HJA technique.The average length of time for hepaticojejunostomy ranged from 22 to 40 minutes, and the postoperative hospital stay was 5.2 to 9.2 days. There were no instances of bile leakage following the operation. At 17 to 30 months of follow-up, there was no abdominal pain or jaundice, and the reexamination of transaminases, bilirubin and amylase were normal.Ultrasonography showed no bile duct stricture or dilated bile ducts, and the incision is elegant and the families of the patients were satisfied. Conclusion: In single-port laparoscopic choledochal cystectomy and Roux-en-Y hepaticojejunostomy（SPCH）in children, The CS-HJA technique is safe and feasible for small-diameter hepaticojejunostomy in SPCH surgery in children.