Differences in post-operative complications after reconstruction for congenital biliary dilatation in a single institution-Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy.
Anastomosis, Roux-en-Y
/ adverse effects
Anastomosis, Surgical
/ adverse effects
Bile Duct Diseases
/ congenital
Bile Ducts, Extrahepatic
/ surgery
Child, Preschool
Dilatation, Pathologic
/ congenital
Duodenum
/ surgery
Female
Hepatectomy
/ methods
Humans
Infant
Jejunostomy
/ adverse effects
Male
Postoperative Complications
/ diagnosis
Plastic Surgery Procedures
/ adverse effects
Retrospective Studies
Choledochal cyst
Congenital biliary dilatation
Hepaticoduodenostomy
Hepaticojejunostomy
Journal
Pediatric surgery international
ISSN: 1437-9813
Titre abrégé: Pediatr Surg Int
Pays: Germany
ID NLM: 8609169
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
accepted:
06
11
2020
pubmed:
24
1
2021
medline:
16
6
2021
entrez:
23
1
2021
Statut:
ppublish
Résumé
The standard surgical procedure for congenital biliary dilatation (CBD) consists of excision of extrahepatic bile duct and Roux-en-Y hepaticojejunostomy (HJ). However, alternative reconstructive operations for CBD includes hepaticoduodenostomy (HD). We compared postoperative complications and therapeutic outcomes of these two operations at our institution. From 1981 to 2009, there were 23 traceable patients who underwent operation for CBD, They were divided into an HJ Group (n = 15) and an HD Group (n = 8). Demographic and outcome data were compared. There were no significant differences in postoperative complications (cholangitis, pancreatitis, and anastomotic stenosis) and current blood test data (AST, ALT, Total Bilirubin, Direct Bilirubin, Amylase) between the two groups. Current abdominal pain and carcinogenesis were not observed in either group. Intrahepatic stones occurred in one patient in each group, both > 25 years post-operation. HD is considered to be an acceptable reconstruction method compared to HJ, based on our results. There has been a suggestion that inadequate diversion in HD might increase the risk of cholangiocarcinoma. To date, in this series, that has not happened.
Sections du résumé
BACKGROUND
BACKGROUND
The standard surgical procedure for congenital biliary dilatation (CBD) consists of excision of extrahepatic bile duct and Roux-en-Y hepaticojejunostomy (HJ). However, alternative reconstructive operations for CBD includes hepaticoduodenostomy (HD). We compared postoperative complications and therapeutic outcomes of these two operations at our institution.
METHODS
METHODS
From 1981 to 2009, there were 23 traceable patients who underwent operation for CBD, They were divided into an HJ Group (n = 15) and an HD Group (n = 8). Demographic and outcome data were compared.
RESULTS
RESULTS
There were no significant differences in postoperative complications (cholangitis, pancreatitis, and anastomotic stenosis) and current blood test data (AST, ALT, Total Bilirubin, Direct Bilirubin, Amylase) between the two groups. Current abdominal pain and carcinogenesis were not observed in either group. Intrahepatic stones occurred in one patient in each group, both > 25 years post-operation.
CONCLUSION
CONCLUSIONS
HD is considered to be an acceptable reconstruction method compared to HJ, based on our results. There has been a suggestion that inadequate diversion in HD might increase the risk of cholangiocarcinoma. To date, in this series, that has not happened.
Identifiants
pubmed: 33483835
doi: 10.1007/s00383-020-04790-1
pii: 10.1007/s00383-020-04790-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
241-245Références
Singham J et al (2007) Choledochal cysts: analysis of disease pattern and optimal treatment in adult and paediatric patients. HPB (Oxford) 9(5):383–387
doi: 10.1080/13651820701646198
O’Neill JA Jr (1992) Choledochal cyst. Curr Probl Surg 29(6):361–410
pubmed: 1582241
Singham J, Yoshida EM, Scudamore CH (2009) Choledochal cysts: part 2 of 3: diagnosis. Can J Surg 52:506–511
pubmed: 20011188
pmcid: 2792398
Ishibashi H, Shimada M, Kamisawa T, Fujii H, Hamada Y, Kubota M, Urushihara N, Endo I, Nio M, Taguchi T, Ando H, Japanese Study Group on Congenital Biliary Dilatation (JSCBD) (2017) Japanese clinical practice guidelines for congenital biliary dilatation. J Hepatobiliary Pancreat Sci 24:1–16
doi: 10.1002/jhbp.415
Narayanan SK, Chen Y, Narasimhan KL, Cohen RC (2013) Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: a systematic review and meta-analysis. J Pediatr Surg 48:2336–2342
doi: 10.1016/j.jpedsurg.2013.07.020
Todani T, Watanabe Y, Mizuguchi T et al (1981) Hepaticoduodenostomy at the hepatic hilum after excision of choledochal cyst. Am J Surg 142:584–587
doi: 10.1016/0002-9610(81)90431-1
Shimotakahara A, Yamataka A, Yanai T, Kobayashi H, Okazaki T, Lane GJ, Miyano T (2005) Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: Which is better? Pediatr Surg Int 21:5–7
doi: 10.1007/s00383-004-1252-1
Takada K, Hamada Y, Watanabe K, Tanano A, Tokuhara K, Kamiyama Y (2005) Duodenogastric reflux following biliary reconstruction after excision of choledochal cyst. Pediatr Surg Int 21:1–4
doi: 10.1007/s00383-004-1251-2
Todani T, Watanabe Y, Toki A, Hara H (2002) Hilar duct carcinoma developed after cyst excision followed by hepatico- duodenostomy. In: Koyanagi Y, Aoki T (eds) Pancreaticobiliary maljunction. Igaku tosho shuppan, Tokyo, pp 17–21
Hamada Y, Hamada H, Shirai T, Nakamura Y, Sakaguchi T, Yanagimoto H, Inoue K, Kon M (2017) Duodenogastric regurgitation in hepaticoduodenostomy after excision of congenital biliary dilatation (choledochal cyst). J Pediatr Surg 52:1621–1624
doi: 10.1016/j.jpedsurg.2017.03.063
Santore MT, Behar BJ, Blinman TA, Doolin EJ, Hedrick HL, Mattei P, Nance ML, Adzick NS, Flake AW (2011) Hepaticoduodenostomy vs. hepaticojejunostomy for reconstruction after resection of choledochal cyst. J Pediatr Surg 46:209–213
doi: 10.1016/j.jpedsurg.2010.09.092
Liem NT, Pham HD, le Dung A, Son TN, Vu HM (2012) Early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 patients. J Laparoendosc Adv Surg Tech A 22:599–603
doi: 10.1089/lap.2012.0018
Yeung F, Fung ACH, Chung PHY, Wong KKY (2020) Short-term and long-term outcomes after Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy following laparoscopic excision of choledochal cyst in children. Surg Endosc 34:2172–2177
doi: 10.1007/s00464-019-07004-5
Goto N, Yasuda I, Uematsu T, Kanemura N, Takao S, Ando K, Kato T, Osada S, Takao H, Saji S, Shimokawa K, Moriwaki H (2001) Intrahepatic cholangiocarcinoma arising 10 years after the excision of congenital extrahepatic biliary dilation. J Gastroenterol 36:856–862
doi: 10.1007/s005350170010