Characteristics, management, and outcomes of congenital biliary dilatation in neonates and early infants: a 20‐year, single‐institution study

Abstract

Background The aim of the present study was to investigate the characteristics, management, and outcomes of congenital biliary dilatation (CBD) in neonates and infants (<1 year old) in a single institution over the past 20 years. Methods From 1997 to 2016, 21 patients <1 year old underwent definitive surgery for CBD. Open surgery (OS) was performed between 1997 and 2008, and laparoscopic surgery (LS) has been performed since 2009. Results The bile duct showed cystic dilatation in all patients. Sixteen (76.2%) of the 21 patients were diagnosed prenatally, and the incidence increased with time (OS 63.6%, LS 90%). Fourteen patients (66.7%) were symptomatic before surgery, with jaundice in 11 (52.4%), acholic stool in seven (33.3%), and vomiting in three (14.3%). There were no significant differences in operation time and blood loss, but the postoperative fasting period and hospital stay were significantly shorter in the LS group (P < 0.05). There were no intraoperative complications, but there was one postoperative early complication in one LS group patient, who had bile leakage and was treated with redo hepaticojejunostomy. Conclusion The incidences of prenatally diagnosed and asymptomatic patients increased with time. Although longer follow-up is needed, LS for CBD could be safely performed even in neonates and early infants.

Comparison of efficacy and safety of laparoscopic excision and open operation in children with choledochal cysts: A systematic review and update meta-analysis

“…Of the above 18 studies, 4 studies were further excluded due to the results of NOS, with score being � 5 stars, which were considered as indicative of low quality. Finally, in total, our analysis included 14 [14][15][16][17][18][19][20][21][22][23][24][25][26][27] retrospective cohort studies comparing LA and OP in the children with CDCs, with 1767 patients (853 in the LA group, 914 in the OP group) enrolled. A flowchart of our analysis protocol has shown in Fig 1. The characteristics and the quality of these 14 studies are listed in Table 1.…”

“…Seven trails [19,20,23,25,26,29,30] reported long-term postoperative complications, including 485 patients (207 in LA group, 278 in OP group, Table 2). Pooled risk difference…”

“…All included studies [17][18][19][20][21][22][23][24][25][26][27][28][29][30] contributed data, including 1767 patients (853 in the LA group, 914 in the OP group; Table 2). Total patient morbidity was 53/853 in the LA group and 178/914 in the OP group.…”

“…occur during postoperative hospitalization, including bile leakage, gastrointestinal dysfunction, anastomotic leakage, and wound infection, et al [26]. Meanwhile, long-term complications refer to those happen during the follow-up period, including adhesive ileus, bile duct obstruction, anastomotic stenosis, pancreatitis, and cholangitis, et al As previous studies showed [8,32], laparoscopy with its umbilicus-to-hepatic hilum direction of vision provides a better view of the deep anatomic structures, such as hepatic hilum, portal vein, and hepatic arteries.…”

“…Frist, the main limitation of this meta-analysis is the lack of randomized controlled trials. Second, most included studies were conducted in Asian health centers except 2 studies perform in American [22] and German [26], respectively, since CDC is more common in Asian nations. Therefore, there was a risk of selection bias even though such confounders could not be avoided.…”