Biliary-enteric reconstruction with hepaticoduodenostomy following laparoscopic excision of choledochal cyst is associated with better postoperative outcomes: a single-centre experience

Yeung, Fanny; Chung, Patrick Ho Yu; Wong, Kenneth K.; Tam, Paul Kwong‐Hang

doi:10.1007/s00383-014-3648-x

Cited by 42 publications

(22 citation statements)

References 25 publications

(37 reference statements)

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“…This ratio does not reflect that of our population [2, 13] but the selection process of the patients included in the study which was dependent on the availability of parental DNA (trios) and willingness to participate.…”

Section: Resultsmentioning

confidence: 89%

Genetic study of congenital bile-duct dilatation identifies de novo and inherited variants in functionally related genes

et al. 2016

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BackgroundCongenital dilatation of the bile-duct (CDD) is a rare, mostly sporadic, disorder that results in bile retention with severe associated complications. CDD affects mainly Asians. To our knowledge, no genetic study has ever been conducted.MethodsWe aim to identify genetic risk factors by a “trio-based” exome-sequencing approach, whereby 31 CDD probands and their unaffected parents were exome-sequenced. Seven-hundred controls from the local population were used to detect gene-sets significantly enriched with rare variants in CDD patients.Results Twenty-one predicted damaging de novo variants (DNVs; 4 protein truncating and 17 missense) were identified in several evolutionarily constrained genes (p < 0.01). Six genes carrying DNVs were associated with human developmental disorders involving epithelial, connective or bone morphologies (PXDN, RTEL1, ANKRD11, MAP2K1, CYLD, ACAN) and four linked with cholangio- and hepatocellular carcinomas (PIK3CA, TLN1 CYLD, MAP2K1). Importantly, CDD patients have an excess of DNVs in cancer-related genes (p < 0.025). Thirteen genes were recurrently mutated at different sites, forming compound heterozygotes or functionally related complexes within patients.ConclusionsOur data supports a strong genetic basis for CDD and show that CDD is not only genetically heterogeneous but also non-monogenic, requiring mutations in more than one genes for the disease to develop. The data is consistent with the rarity and sporadic presentation of CDD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12920-016-0236-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 89%

Genetic study of congenital bile-duct dilatation identifies de novo and inherited variants in functionally related genes

et al. 2016

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“…Yeung et al . evaluated short‐term outcomes between laparoscopic hepaticojejunostomy and hepaticoduodenostomy in their review of 31 patients . They saw better outcomes in the patients that had hepaticoduodenostomy for their biliary reconstruction with no postoperative events of cholangitis or reoperation compared with 5% developing cholangitis and 25% undergoing reoperation after hepaticojejunostomy.…”

Section: Choledochal Cystsmentioning

confidence: 99%

Transitional care for patients with surgical pediatric hepatobiliary disease: Choledochal cysts and biliary atresia

Aspelund

Mahdi

Rothstein

et al. 2019

J of Gastro and Hepatol

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Choledochal cysts (CDCs) and biliary atresia (BA) are rare pediatric hepatobiliary anomalies that require surgical intervention due to increased risk of malignancy and liver failure, respectively. The underlying disease and operative procedures place patients at risk for long‐term complications, which may continue to affect them into adulthood. Lack of a transitional care model in the health‐care system potentiates the challenges they will face following aging out of their pediatric providers' care. We sought to elucidate the long‐term complications and challenges patients with CDCs and BA face, review the current literature regarding transitioning care, and propose guidelines aiding adult providers in continued care and surveillance of these patients. A literature review was performed to assess short‐term and long‐term complications after surgery and the current standards for transitioning care in patients with a history of CDCs and BA. While transitional programs exist for patients with other gastrointestinal diseases, there are few that focus on CDCs or BA. Generally, authors encourage medical record transmission from pediatric to adult providers, ensuring accuracy of information and compliance with treatment plans. Patients with CDCs are at risk for developing biliary malignancies, cholangitis, and anastomotic strictures after resection. Patients with BA develop progressive liver failure, necessitating transplantation. There are no consensus guidelines regarding timing of follow up for these patients. Based on the best available evidence, we propose a schema for long‐term surveillance.

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“…Although the exact mechanisms for cancer development are not yet fully understood, many investigators have asserted that inflammatory stimulation is related to cholangiocarcinoma development [3, 15, 16]. Furthermore, food or bile reflux can cause clinical symptoms such as abdominal pain, nausea, and vomiting [10, 17]. Of the 65 patients who underwent upper gastrointestinal imaging, 3 had slight contrast agent reflux, yielding a reflux incidence rate of 4.62%.…”

Section: Discussionmentioning

confidence: 99%

Modified biliary-enteric anastomosis for congenital choledochal cyst: clinical and prognostic analysis of 91 cases

Jiang

et al. 2017

Pediatr Surg Int

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PurposeTo report our experience with a modified biliary-enteric anastomosis procedure for the surgical treatment of congenital choledochal cysts.MethodsBetween January 2009 and December 2013, 91 children (19 boys, 72 girls; ages, 6–145 months) with congenital choledochal cysts were treated with our modified surgical procedure in our hospital. Of these patients, 69 had type I cysts, and 22 had type IV B cysts. The main parameters analyzed mainly included the operative time, duration of bowel recovery, resumption of diet, postoperative hospital stay, liver-function tests, postoperative complications, and prognosis.ResultsThe average operation duration was 129.34 ± 23.50 min. The time until first flatus and resumption of oral diet were 26.51 ± 4.13 h and 5.47 ± 0.77 day, respectively. The mean postoperative hospital stay was 11.84 ± 2.58 day. Postoperative complications occurred in six patients: intestinal obstruction (1 patient), postoperative bleeding (1 patient), postoperative pancreatitis (1 patient), and bile leakage (3 patients). During a follow-up of 2–7 years, four cases of occasional abdominal pain were found. Contrast agent reflux was detected on upper gastrointestinal imaging in three children. All children had good nutrition.ConclusionThe modified biliary-enteric anastomosis is a safe, simple, and reliable technique. However, longer follow-up and a larger sample size are necessary to prove its efficacy in the treatment of congenital choledochal cysts.

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Biliary-enteric reconstruction with hepaticoduodenostomy following laparoscopic excision of choledochal cyst is associated with better postoperative outcomes: a single-centre experience

Abstract: Laparoscopic excision of choledochal cyst with hepaticoduodenostomy reconstruction is safe and feasible with shorter operative time, ICU stay and overall hospital stay. It is not inferior to HJ in terms of short-term postoperative outcomes.

Cited by 42 publications

References 25 publications

Genetic study of congenital bile-duct dilatation identifies de novo and inherited variants in functionally related genes

Genetic study of congenital bile-duct dilatation identifies de novo and inherited variants in functionally related genes

Transitional care for patients with surgical pediatric hepatobiliary disease: Choledochal cysts and biliary atresia

Modified biliary-enteric anastomosis for congenital choledochal cyst: clinical and prognostic analysis of 91 cases

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