Comparative analysis of the bile duct reconstruction methods in children with choledochal malformation

Razumovskiy, A. Yu.; Mitupov, Z. B.; Kulikova, N. V.; Степаненко, Н. С.; Zadvernyuk, A. S.; Adler, A; Shubin, Ni

doi:10.17116/hirurgia202108149

Cited by 2 publications

(5 citation statements)

References 15 publications

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“…3,35,[45][46][47] There is a need for long-term follow-up to determine the outcomes of HD and RNYHJ reconstruction after choledochal cyst excision. Prior studies have attempted to address the controversy between HD and RNYHJ by demonstrating similar short-term outcomes, 4,5,9,[15][16][17] although there are some reports of increased rates of biliary reflux, gastritis, and pancreatitis with HD 6,13,[15][16][17][18] with the concern that biliary reflux may contribute to the development of carcinoma. 4,15,17,18 Our study suggests HD has a higher readmission rate than RNYHJ, which may be due to these higher rates of reflux after HD 6,13,[15][16][17][18] ; however, this should be weighed against the advantages of a more physiologic reconstruction, subsequent endoscopic access if needed for future procedures, and the decreased risk of an internal hernia.…”

Section: Discussionmentioning

confidence: 99%

“…RNYHJ reconstruction has been associated with malabsorption; therefore, some surgeons prefer HD for a more physiologic reconstruction 8,12,14 . Yet, HD has been associated with increased rates of postoperative reflux, gastritis, and pancreatitis 13,15–18 . Although controversy remains regarding the difference in long‐term complications between these reconstructions, studies have shown HD and RNYHJ to have similar short‐term outcomes 13,18–22 …”

Section: Introductionmentioning

confidence: 99%

“…8,12,14 Yet, HD has been associated with increased rates of postoperative reflux, gastritis, and pancreatitis. 13,[15][16][17][18] Although controversy remains regarding the difference in long-term complications between these reconstructions, studies have shown HD and RNYHJ to have similar short-term outcomes. 13,[18][19][20][21][22] Over recent years, HD reconstruction has become more frequently adopted for reconstruction due to the increasing use of minimally invasive surgery (MIS) in children.…”

Section: Introductionmentioning

confidence: 99%

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Contemporary trends in choledochal cyst excision: An analysis of the pediatric national surgical quality improvement program

Howell,

Beckhorn,

Antiel

et al. 2024

World j. surg.

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BackgroundCholedochal cysts are rare congenital anomalies of the biliary tree that may lead to obstruction, chronic inflammation, infection, and malignancy. There is wide variation in the timing of resection, operative approach, and reconstructive techniques. Outcomes have rarely been compared on a national level.MethodsWe queried the Pediatric National Surgical Quality Improvement Program (NSQIP) to identify patients who underwent choledochal cyst excision from 2015 to 2020. Patients were stratified by hepaticoduodenostomy (HD) versus Roux‐en‐Y hepaticojejunostomy (RNYHJ), use of minimally invasive surgery (MIS), and age at surgery. We collected several outcomes, including length of stay (LOS), reoperation, complications, blood transfusions, and readmission rate. We compared outcomes between cohorts using nonparametric tests and multivariate regression.ResultsAltogether, 407 patients met the study criteria, 150 (36.8%) underwent RNYHJ reconstruction, 100 (24.6%) underwent MIS only, and 111 (27.3%) were less than one year old. Patients who underwent open surgery were younger (median age 2.31 vs. 4.25 years, p = 0.002) and more likely underwent RNYHJ reconstruction (42.7% vs. 19%, p = 0.001). On adjusted analysis, the outcomes of LOS, reoperation, transfusion, and complications were similar between the type of reconstruction, operative approach, and age. Patients undergoing RNYHJ had lower rates of readmission than patients undergoing HD (4.0% vs. 10.5%, OR 0.34, CI [0.12, 0.79], p = 0.02).ConclusionsIn children with choledochal cysts, most short‐term outcomes were similar between reconstructive techniques, operative approach, and age at resection, although HD reconstruction was associated with a higher readmission rate in this study. Clinical decision‐making should be driven by long‐term and biliary‐specific outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Contemporary trends in choledochal cyst excision: An analysis of the pediatric national surgical quality improvement program

Howell,

Beckhorn,

Antiel

et al. 2024

World j. surg.

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“…In addition, during the operation, pulling, clamping, and other maneuvers cause tissue trauma leading to bleeding and long recovery times after the operations. 9 , 10 …”

Section: Discussionmentioning

confidence: 99%

“…In addition, during the operation, pulling, clamping, and other maneuvers cause tissue trauma leading to bleeding and long recovery times after the operations. 9,10 At our hospital, we have successfully performed many laparoscopic cyst resections in combination with Roux-en-Y hepaticojejunostomy. Our surgeons, therefore, are highly skilled and have accumulated a rich experience.…”

Section: Discussionmentioning

confidence: 99%

Comparison of open and laparoscopic outcomes of adult Type-I congenital choledochal cysts

Lu,

Hou

2023

Pak J Med Sci

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Objective: To compare open and laparoscopic outcomes of adult Type-I congenital choledochal cysts. Methods: Clinical data of 78 adult patients with Type-I congenital choledochal cysts, who had undergone cyst resection and Roux-en-Y hepaticojejunostomy in Chenzhou First People’s Hospital from September 1, 2021 to August 31, 2022, were retrospectively analyzed. Patients who received open approach and Roux-en-Y hepaticojejunostomy constituted the open group (n=35,) and patients who received laparoscopic approach and Roux-en-Y hepaticojejunostomy were assigned into the laparoscopic group (n=43,). The intraoperative and postoperative conditions, relevant laboratory indicators, and the rate of complications were compared between the two groups. Results: Intraoperative blood loss, postoperative time to first flatus, diet recovery time, time to drainage tube removal, and length of hospitalization of the laparoscopic group were lower in the laparoscopic group compared to the open group (P<0.05). One day after the operation, serum amylase (SAMY) levels in both groups were significantly lower, while the levels of total bilirubin(TBIL), alanine aminotransferase(ALT), and C-reactive protein(CRP) were higher than before the operation. Postoperative SAMY level in the laparoscopic group was significantly higher, while the postoperative TBIL and CRP levels were significantly lower than those in the open group (P<0.05). The incidence of postoperative complications in the laparoscopy group (4.65%) was significantly lower than the open group (20.00%) (P<0.05). Conclusions: Laparoscopic cyst resection combined with Roux-en-Y hepaticojejunostomy is associated with lower extent of trauma, faster recovery, less inflammation, and fewer complications than open surgery in adult patients with Type-I congenital choledochal cysts. doi: https://doi.org/10.12669/pjms.39.6.7829 How to cite this: Lu H, Hou W. Comparison of open and laparoscopic outcomes of adult Type-I congenital choledochal cysts. Pak J Med Sci. 2023;39(6):---------. doi: https://doi.org/10.12669/pjms.39.6.7829 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Comparative analysis of the bile duct reconstruction methods in children with choledochal malformation

Cited by 2 publications

References 15 publications

Contemporary trends in choledochal cyst excision: An analysis of the pediatric national surgical quality improvement program

Contemporary trends in choledochal cyst excision: An analysis of the pediatric national surgical quality improvement program

Comparison of open and laparoscopic outcomes of adult Type-I congenital choledochal cysts

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