Outcomes of laparoscopic versus open resection of pediatric choledochal cyst

Ramsey, Walter A.; Huerta, Carlos Theodore; Ingle, Shreya M.; Gilna, Gareth P.; Saberi, Rebecca A.; O’Neil, Christopher F.; Ribieras, Antoine J.; Parreco, Joshua; Pérez, Eduardo; Sola, Juan E.; Thorson, Chad M.

doi:10.1016/j.jpedsurg.2022.12.024

Cited by 7 publications

(14 citation statements)

References 21 publications

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“…Prior studies have shown a decreased LOS for patients who undergo choledochal cyst excision through an MIS approach, particularly robotically 13,28,33,34 . One small prospective randomized trial showed decreased LOS with MIS among other benefits 49 .…”

Section: Resultsmentioning

confidence: 99%

“…Prior studies have shown a decreased LOS for patients who undergo choledochal cyst excision through an MIS approach, particularly robotically. 13,28,33,34 One small prospective randomized trial showed decreased LOS with MIS among other benefits. 49 Our unadjusted data agreed with these findings; however, we did not find LOS to be associated with MIS on linear regression (p = 0.87).…”

Section: Discussionmentioning

confidence: 99%

“…There is wide variation in the techniques of reconstruction after choledochal cyst excision. The most common management approach historically has been resection with Roux‐en‐Y hepaticojejunostomy (RNYHJ); however, this practice has been challenged recently, with increasing use of hepaticoduodenostomy (HD) 4–13 . RNYHJ reconstruction has been associated with malabsorption; therefore, some surgeons prefer HD for a more physiologic reconstruction 8,12,14 .…”

Section: Introductionmentioning

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%

“…Prior studies have examined outcomes of HD versus RNYHJ reconstruction, although many have been limited to meta‐analyses, small institutional studies, or international cohorts 4–12,14,15,20,21,24,33,38 . Very few utilize large national databases 13 . The goal of our study was to define contemporary trends and compare outcomes stratified by type of reconstruction (HD vs. RNYHJ), use of MIS, and age at excision using a large national database to identify the practice variations and determine best practice for age, approach, and reconstruction.…”

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: Resultsmentioning

confidence: 99%