Comparison between hepaticojejunostomy and hepaticoduodenostomy after excision of choledochal cyst in children: a cohort study

Abstract

ObjectiveHepaticojejunostomy (HJ) and hepaticoduodenostomy (HD) are commonly used biliary reconstruction techniques after choledochal cyst excision. HD has been suggested to be a more physiologic alternative during reconstruction. The objective of this study is to compare operative time, hospital stay, morbidity (leak, cholangitis, ileus, and obstruction), and mortality between HJ and HD after cyst excision.MethodsThis is a 14-year retrospective cohort study of pediatric patients (≤18 years old) who underwent choledochal cyst excision and subsequent biliary reconstruction at the Philippine Children’s Medical Center. Data were taken from inpatient charts, operative technique, OPD logbook, readmission, and OPD charts.ResultsThere were 122 patients: 56% HD and 44% HJ. Majority were female (72%), with 1:2.6 male to female ratio. The average age was 36.1 months, with a mean follow-up of 32.8 months (range 6 months–14 years). The most common cyst was type I (87%). Operative time was longer for HJ compared with HD (321.3 vs 203.6 min; p=0.000). Hospital stay was longer with HJ compared with HD (7.7 vs 6.8 days; p=0.002). Mortality rate was low at 1.6% while morbidity was at 13.9% in both groups. Although morbidity was higher among those who underwent HD, there was no significant difference between the two procedures. Anastomotic leak (4%) and cholangitis (7.4%) were observed in HD, and ileus (7.4%) was observed in the HJ group.ConclusionsIn our series, HD provided less operative time and hospital stay than with HJ. We did not observe bile gastritis after HD as compared with others. It is suggested that longer follow-up is needed to confirm such findings.

Outcome of Biliary-enteric Reconstruction with Hepaticoduodenostomy Following Choledochal Cyst Resection: A Prospective Study

“…An attempt at meta-analysis of important studies published in the last 4 decades using HD for biliary enteric continuity following choledochal cyst resection is shown in Table 3 . [ 1 4 5 10-15 17 18 19 20 21 ] In our prospective study, minor complications (9) such as minor wound infection (4) and post-operative haemorrhagic nasogastric aspirate (5) were also recorded, while most series were retrospective and rarely mention these minor complications. [ 1 4 5 10-15 17 18 19 20 21 ] The percentage of the rest of the complications (18.92%, 14/74) was similar to the rest of the studies published in the literature.…”

“…[ 1 4 5 10-15 17 18 19 20 21 ] In our prospective study, minor complications (9) such as minor wound infection (4) and post-operative haemorrhagic nasogastric aspirate (5) were also recorded, while most series were retrospective and rarely mention these minor complications. [ 1 4 5 10-15 17 18 19 20 21 ] The percentage of the rest of the complications (18.92%, 14/74) was similar to the rest of the studies published in the literature. As per our meta-analysis described in Table 4 , the percentage of overall post-operative complications was slightly higher with HJ (14.95%) than HD (12.5%).…”

“…As per our meta-analysis described in Table 4 , the percentage of overall post-operative complications was slightly higher with HJ (14.95%) than HD (12.5%). [ 1 4 5 10-15 17 18 19 20 21 ] Post-operative bile gastritis was seen exclusively with HD (2.67%), while post-operative intestinal obstruction was seen solely with HJ (1.71%). Comparative evaluation of post-operative complications with HD and HJ is elaborated in Table 4 .…”

Prenatal Diagnosis of Type 1c Choledochal Cysts in 1 Month Old Baby

“…The definitive treatment for CCs are total excision, which has been suggested being able to fully decrease the risk of malignant degeneration. The general aim is to remove the cyst completely and restore biliary enteric drainage either into the duodenum by hepaticoduodenostomy (HD) or jejunum by Roux-en-Y hepaticojejunostomy (RYHJ), although varying approaches for different types of CCs may be very slightly dissimilar [6,[11][12][13][14][15].…”

Laparoscopic management of choledochal cyst in children

“…Although there was no report of the size of the fusiform (Type I) CCs encountered during the study, it is very common among Filipinos to have a late diagnosis thus with a big cyst size and perhaps not amenably safe for a laparoscopic approach. [ 52 ]…”