The Feasibility and Safety of Transumbilical Single-Incision Laparoscopic Surgery for Giant Choledochal Cyst in Infants: A Single-Center Retrospective Study

Background Radical resection of giant choledochal cysts (diameter ≥ 10 cm) in infants is technically challenging due to the limited abdominal space and the cyst's mass effect, which complicate minimally access surgery. Transumbilical laparoendoscopic single-site surgery (LESS) offers potential cosmetic and minimally invasive advantages. However, its feasibility and safety for managing these giant cysts remain inadequately investigated. Methods In this single-center, retrospective study with a historical control design, we analyzed infants undergoing radical surgery for giant choledochal cysts between June 2016 and December 2024. The final follow-up for the entire cohort was censored on September 30, 2025. Patients were categorized into the LESS group (n = 9) or the open surgery group (n = 18). The ransumbilical LESS procedure incorporated cyst decompression and a novel "relay suspension technique" to overcome technical challenges. Perioperative and long-term outcomes were compared between the two groups. Results The two groups were comparable in baseline characteristics. Although the LESS group had a significantly longer operative time (median 3.43 vs. 2.46 hours, p = 0.006), it was associated with reduced intraoperative blood loss (median 10.0 vs. 20.0 ml, p < 0.001), a shorter postoperative fasting time (median 2 vs. 3 days, p = 0.011), and a shorter duration of abdominal drainage (median 0 vs. 4 days, p = 0.001). Postoperative hospital stay and complication rates were similar between the two groups. No conversions to open surgery occurred in the LESS group. During follow-up (median: 33 months for LESS, 80 months for open surgery), no late complications were observed in either group, and the LESS group achieved a virtually scarless cosmetic outcome. Conclusions The transumbilical LESS approach combined with cyst decompression and the "relay suspension technique" is feasible and safe for the treatment of giant choledochal cysts in infants when performed at experienced centers. It offers significant minimally invasive advantages, including reduced blood loss and faster recovery in certain parameters, without compromising surgical safety, and demonstrates excellent long-term and superior cosmetic outcomes comparable to those of open surgery.