Pediatric Choledochal Cysts; Hepaticoduodenostomy for Biliary Reconstruction; Is it Time to Get Title of “Gold Standard” from Hepaticojejunostomy? 25 years of Single Centre Experience

Gezer HÖ, Karaman I, Karaman A and Çakmak O

Department of Pediatric Surgery, Dr. Sami Ulus Children Health and Diseases Training and Research Hospital, Başkent University, Turkey

^*Correspondance to: Hasan Özkan Gezer 

 PDF  Full Text DOI: 10.25107/2474-1647.2616

Abstract

Background: Choledochal Cysts (CCs) are a rare entity; especially in the Western world. A complete consensus has not been reached regarding how bile drainage will be provided after the excision. We aimed to evaluate the patients treated with a diagnosis of CC in our clinic and to reveal the results focusing on outcomes of the two hepaticoenterostomy methods. Method: We reviewed all pediatric patients operated for CC<18 years of age in a pediatric surgery clinic at a tertiary hospital between 1992 and 2017, and excluded treated with internal drainage (ID), ID+ External Drainage (ED) and total Cyst Excision (CE) were excluded from the present analysis. Results: Of 25 patients with CCs, 7 were male (28%). The mean age was 2.7 years (range between 7 days to 13.6 years). Type I and IVb cysts were diagnosed in 22, and 3 patients, respectively. Total CE+ hepaticoduodenostomy (HD) or Hepaticojejunostomy (HJ) were performed in 10, and 15 patients respectively. Ten HD patients had no long-term complications. However, adhesions (n=1) and anastomotic strictures (n=1) were seen in HJ patients that anastomotic stricture required reoperation. The mean follow-up period was 14 years (range between 6 years and 18 years). We did not observe biliary malignancies during treatment or follow-up. Conclusion: In our study, patients with total CE+HD have no long-term complications and it was also confirmed by hepatic scintigraphy that there was neither gastric nor hepatic reflux. Despite a limited number of patients but with a long follow-up, our study supports the competition between HD and HJ regarding bile drainage in the literature in favor of HD.

Keywords

Choledochal cysts; Children; Hepaticojejunostomy; Hepaticoduodenostomy

Cite the article

Gezer HÖ*, Karaman I, Karaman A, Çakmak O. Pediatric Choledochal Cysts; Hepaticoduodenostomy for Biliary Reconstruction; Is it Time to Get Title of “Gold Standard” from Hepaticojejunostomy? 25 years of Single Centre Experience. Clin Surg. 2019; 4: 2616..