Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: which is better?

Shimotakahara, Akihiro; Yamataka, Atsuyuki; Yanai, Toshihiro; Kobayashi, Hiroyuki; Okazaki, Tadaharu; Lane, Geoffrey J.; Miyano, Takeshi

doi:10.1007/s00383-004-1252-1

Cited by 109 publications

(81 citation statements)

References 14 publications

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“…Some study like Shimotakahara et al and Elhalaby et al disfavours due to high duodenogastric bile reflux, while Silva-Baez et al and Mukhopadhyay et al, favours the procedure of HD due to shorter operative time and avoidance of intestinal anastomosis. [20][21][22][23] A recent meta-analysis study by Narayanan et al support the procedure of cyst excision and RYHJ. 24 In our experience, we have done HD in five cases, in two of them developed post-operative minor bile leak in drain that improve on conservative measures no redo surgical intervention required.…”

Section: Discussionmentioning

confidence: 99%

Congenital choledochal malformations in children: management strategies

2017

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Background: A Congenital Choledochal Malformations (CCM) is common congenital defect of biliary tree in Asian subcontinent. Presentations of CCM are vague from asymptomatic to life threatening cholangitis or pancreatitis. Complete cyst excision and bilioenteric anastomosis is now accepted surgical treatment.Methods: This is a retrospective study of five years duration. In this study the clinical presentation, haematological, biochemical and radiological findings, operative procedure and outcome were studied from case records.Results: Total of 20 patients were studied, with clinical presentation of recurrent abdominal pain in eight cases, previous history of cholangitis in five cases, acute cholangitis two cases, biliary peritonitis in four cases and previous history of pancreatitis in one case. In 13 cases Roux-en-Y hepaticojejunostomy (RYHJ) and in 4 cases hepaticoduodenostomy (HD) done after cyst excision. One case of type II CCM managed with only cyst excision, in two cases Lilly’s procedure, one case requires temporary external drainage and in two cases temporary internal drainage done in view on cholangitis and jaundice.Conclusions: However, the definitive treatment of CCM is complete cyst excision and bilioenteric anastomosis, though lot of other temporary majors are also required at different stages of disease.

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Section: Discussionmentioning

confidence: 99%

Congenital choledochal malformations in children: management strategies

2017

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“…Which are less likely to occur with hepaticojejunostomy [56]. Overall, the paradigm shift is more toward hepaticojejunostomy, because its complications rates are less 7% compared to hepaticoduodenostomy of 42% [57,58].…”

Section: Treatmentmentioning

confidence: 99%

Choledochal Cyst: A Report of 3 Cases and a Review of its Treatment and Outcome

Wabada¹,

Abubukar²,

Bwala³

et al. 2017

Surgery Curr Res

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Choledochal cyst (CC) is not common in Africans. Unlike biliary atresia, this condition commonly presents in late infancy and early childhood, and occasionally also in adults. Typical pattern of presentation is with abdominal mass, abdominal pain and seldom intermittent jaundice. These conventional presentations can be sometimes heralded by chollangitis, malnutrition, and failure to thrive in some category of patients with delayed presentation.Case 1 was a 2-month-old girl who developed fluctuating jaundice on the 5th day of life, associated steatorrhoea, and yellowish discolouration of the urine and occasional bilious vomiting. Ten days before presentation she developed low grade fever, excessive crying and refused to suck. She was resuscitated and hepaticoduodenostomy was performed between the second part of the duodenum and the stump of the common hepatic duct.Case 2 was a 4-year-old girl who presented with a 5-month history of fluctuating jaundice associated abdominal pain, epigastric swelling, weight loss and occasional non-bilious vomiting. A retrocolic end-to-side Roux-en-Y hepaticodochojejunostomy was performed after nutritional rehabilitation.Case 3 was a 5-year old girl with intermittent jaundiced noticed 2-months before presentation, right hypochondrial swelling and colicky right sided abdominal pain almost of same duration. Intraoperatively features of likely cirrhotic liver changes in addition to a huge choledochal cyst were seen. An end to side Roux-en-Y hepaticochojejunostomy was established to the stump of the common hepatic duct.All the cases did well after surgery and were discharged. Regardless of the clinical features, and the morphological changes in the liver, excision of the cyst with establishment of free flowing hepatoenterostomy should be done. Patients' general outlook can be immediately improved after excision of the cyst with hepatoenterostomy. Because the complications of caused by bile flow obstruction are remarkably reduced or rather eliminated. We hereby report three cases we recently managed in our centre with complications of choledochal cyst which improved after excision of the cyst with creation of hepatoenterostomy.

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“…Other authors in comparative trials have also come to the same conclusion. [17] Therefore, what is wrong with hepaticojejunostomyen-Roux? In our opinion, not much.…”

Section: Fig 4 a And B Type 1c Cm: Ree-month-old Girl With A Cyst mentioning

confidence: 99%