Chen GB, Wang ZL, Sha YG, Tang RM, Li DY. Letter to the Editor: Round ligament fixation: A promising alternative for the prevention of hepatic cyst recurrence. World J Gastrointest Surg 2026; 18(7): 116841 [DOI: 10.4240/wjgs.116841]
Corresponding Author of This Article
Da-Yong Li, MD, Chief Physician, Department of General Surgery, The Second People’s Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, No. 6 Du Chun Road, Jinghu District, Wuhu 241000, Anhui Province, China. ldywhey1101@163.com
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Gastroenterology & Hepatology
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letter
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Chen GB, Wang ZL, Sha YG, Tang RM, Li DY. Letter to the Editor: Round ligament fixation: A promising alternative for the prevention of hepatic cyst recurrence. World J Gastrointest Surg 2026; 18(7): 116841 [DOI: 10.4240/wjgs.116841]
World J Gastrointest Surg. Jul 27, 2026; 18(7): 116841 Published online Jul 27, 2026. doi: 10.4240/wjgs.116841
Letter to the Editor: Round ligament fixation: A promising alternative for the prevention of hepatic cyst recurrence
Guang-Bin Chen, Zhi-Lin Wang, Yan-Guang Sha, Rong-Mei Tang, Da-Yong Li
Guang-Bin Chen, Rong-Mei Tang, Department of Hepato-Pancreato-Biliary Surgery, The Second People’s Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu 241000, Anhui Province, China
Guang-Bin Chen, Zhi-Lin Wang, Yan-Guang Sha, Graduate School, Wannan Medical College, Wuhu 241000, Anhui Province, China
Da-Yong Li, Department of General Surgery, The Second People’s Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu 241000, Anhui Province, China
Co-first authors: Guang-Bin Chen and Zhi-Lin Wang.
Co-corresponding authors: Rong-Mei Tang and Da-Yong Li.
Author contributions: Chen GB, Wang ZL, and Sha YG performed literature retrieval; Chen GB and Wang ZL wrote the original draft, and they contributed equally to this manuscript and are co-first authors; Tang RM and Li DY contributed to conceptualization, writing, review, editing, and project administration, and they contributed equally as co-corresponding authors. All the authors approved the final manuscript.
AI contribution statement: In the preparation of this study, Claude Sonnet 4.6 (Anthropic) was used exclusively for language polishing, translation assistance, and writing refinement. The scientific content, clinical perspectives, and all conclusions represent the original intellectual contribution of the authors. The authors take responsibility for the integrity and accuracy of the submitted work.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Da-Yong Li, MD, Chief Physician, Department of General Surgery, The Second People’s Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, No. 6 Du Chun Road, Jinghu District, Wuhu 241000, Anhui Province, China. ldywhey1101@163.com
Received: November 21, 2025 Revised: December 24, 2025 Accepted: March 3, 2026 Published online: July 27, 2026 Processing time: 248 Days and 1.9 Hours
Abstract
We commend on the retrospective study published in the World Journal of Gastrointestinal Surgery by Wu et al for describing laparoscopic fenestration reinforced by suturing the round ligament of the liver to the cyst wall, leveraging autologous tissue to maintain patency and potentially reduce recurrence. The reported series demonstrated technical feasibility, minimal morbidity, and encouraging early radiological responses. We highlight the practical advantages over omental transposition - ready availability, the ability to reach high-dome lesions, and avoidance of omental traction. However, several points require clarification. These include patient selection (solitary vs polycystic disease), management of biliary communication, cyst location and size thresholds, suture choice and tension to avoid ischemic necrosis, and criteria for drain removal and imaging follow-up. To define durability, we advocate for prospective comparative studies against standard fenestration with or without omentoplasty, based on standardized endpoints. Key outcomes should include symptom relief, recurrence-free survival, reintervention, quality of life, and follow-up beyond 12 months. Additionally, we provide practical considerations to guide broader adoption.
Core Tip: Wu et al introduced a novel technique that uses the round ligament of the liver to prevent hepatic cyst recurrence after laparoscopic fenestration. This approach offers distinct advantages, including consistent anatomical availability, superior reach to high-dome lesions, and avoidance of omental mobilization. Critical gaps remain regarding optimal patient selection, technical standardization of suture placement, and long-term recurrence rates beyond 12 months. Prospective comparative trials with patient-reported outcomes and extended surveillance are essential to validate this autologous solution and to establish its role in contemporary surgical practice.
