Does antenatal diagnosis affect the outcome of choledochal cyst?

Abstract

Background: Advances in antenatal imaging has enabled diagnosis of choledochal cysts to be made during the antenatal period; whether this affects the outcome remains undetermined. The objective of this study is to evaluate the effect of antenatal diagnosis on the timing and outcome of surgery. Materials and methods: A retrospective study was conducted of patients with laparoscopic excision of choledochal cysts in a single-center between 2005 and 2017. The clinical presentations, operative details and outcomes were compared between two groups; antenatal (AN) vs postnatal (PN) diagnosis. Results: A total of 42 patients were identified, 2 were excluded for incomplete data. Eleven (28%) patients had antenatal diagnosis and underwent surgery prior to symptoms at a mean age at operation of 21.7 months. In contrast, the PN group all presented symptomatically and they were operated at significantly older age of 54.7 months (p = 0.03). There was no significant difference in the operative duration (AN vs PN=299+/-121mins vs 321+/-130 mins, p=0.66). There was a higher conversion rate in the PN group although not statistically significant (AN vs PN=1:9, p=0.15).In terms of complication rate, there was no significant difference (Clavien-Dindo grade IIIb or above) between AN (18%) vs PN (17%) (p=0.94); time to enteral feeding (AN 5.1 days vs PN 4.7 days, p=0.98) and length of hospital stay (AN 9.6 days vs PN 12 days, p=0.98). Conclusion: Antenatal diagnosis of choledochal cysts allows for earlier definitive surgery. With comparable operative times and complication rates, laparoscopic excision at an earlier age is recommended.