Treatment of choledochal cyst in a pediatric population. A single institution experience of 15-years. Case series

Silva-Báez, Héctor; Coello-Ramírez, P; Ixtabalán-Escalante, Eddy Mizraím; Sotelo-Anaya, Eduardo; Gallo-Morales, Mariana; Cordero-Estrada, Eduardo; Sainz-Escárrega, Victor Hugo; Ploneda-Valencia, C.F.

doi:10.1016/j.amsu.2015.12.054

Cited by 19 publications

(34 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Congenital choledochal malformations in children: management strategies

2017

View full text Add to dashboard Cite

show abstract

“…Generally, 80-90% of choledochal cyst present in the infancy and childhood, [30] the remaining 20% of cases are seen in adults. The less frequent ones are the types that usually present asymptomatic [31,32].…”

Section: Diagnostic Evaluationmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…In a 15-year review of Silva-Baez et al 2 last 2015 in patients who underwent HJ anastomosis, they have found a 25% complication rate compared with those who had HD anastomosis, which had a rate of 16.6%. Complications include cholangitis, leak and postoperative reflux.…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of choledochal cyst commonly involves excision of the cyst, but the biliary enteric continuity can be achieved with different reconstruction techniques 2. Some surgeons prefer to use hepaticojejunostomy (HJ) anastomosis with an Roux-en-Y limb, while others use hepaticoduodenostomy (HD) reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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

Guzman

Resurreccion

Suntay

et al. 2019

World Jnl Ped Surgery

View full text Add to dashboard Cite

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.

show abstract

Treatment of choledochal cyst in a pediatric population. A single institution experience of 15-years. Case series

Cited by 19 publications

References 26 publications

Congenital choledochal malformations in children: management strategies

Congenital choledochal malformations in children: management strategies

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

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

Contact Info

Product

Resources

About