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Article: Short-term and long-term outcomes after Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy following laparoscopic excision of choledochal cyst in children

TitleShort-term and long-term outcomes after Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy following laparoscopic excision of choledochal cyst in children
Authors
KeywordsLaparoscopic biliary-enteric reconstruction
Hepaticoduodenostomy
Hepaticojejunostomy
Choledochal cyst
Long-term outcomes
Issue Date2019
PublisherSpringer New York LLC. The Journal's web site is located at http://link.springer-ny.com/link/service/journals/00464/
Citation
Surgical Endoscopy, 2019, Epub 2019-07-24 How to Cite?
AbstractBackground: Choledochal cysts are congenital dilations of the biliary tree. Complete cyst excision and biliary-enteric reconstruction have been the standard operations. In our center, more than 95% of choledochal cyst excision is now performed laparoscopically. Majority of current studies describe laparoscopic-assisted reconstruction using Roux-en-Y hepaticojejunostomy (HJ). However, only a few have studied laparoscopic hepaticoduodenostomy (HD) as an alternative method of biliary-enteric reconstruction. In this study, we focused on comparing longer-term outcomes between laparoscopic HJ and HD reconstruction following choledochal cyst excision. Methods: We performed retrospective analysis of 54 children who had undergone laparoscopic choledochal cyst excision and biliary-enteric reconstruction between October 2004 and April 2018. Short-term outcomes including operative time, complications such as anastomotic leakage and bleeding, and hospital stays were included. Long-term outcomes including contrast reflux into biliary tree, cholangitis, anastomotic strictures, and need of reoperation were analyzed. Results: Of the 54 patients, 21 of them underwent laparoscopic HD and 33 underwent laparoscopic Roux-en-Y HJ anastomosis reconstruction. There were no significant differences in gestation, gender, age at operation, antenatal diagnosis, and Todani type of choledochal cyst between HD and HJ group. Operative time was significantly shortened in HD group (p = 0.001). Median time to enteral feeding was 3 days in both groups. Median intensive care unit (p = 0.001) and hospital stay (p = 0.019) were significantly shorter in HD group. There was no perioperative mortality. There was no significant difference in anastomotic leakage requiring reoperation (p = 0.743). There were no significant differences in long-term outcomes including anastomotic stricture (p = 0.097), cholangitis (p = 0.061), symptoms of recurrent abdominal pain or gastritis (p = 0.071), or need of reoperation (p = 0.326). All patients had normal postoperative serum bilirubin level. Conclusions: Laparoscopic excision of choledochal cyst with HD reconstruction is safe and feasible with better short-term outcomes and comparable long-term outcomes compared to Roux-en-Y HJ reconstruction.
Descriptioneid_2-s2.0-85069712663link_to_subscribed_fulltext
Persistent Identifierhttp://hdl.handle.net/10722/281900
ISSN
2019 Impact Factor: 3.149
2015 SCImago Journal Rankings: 1.695

 

DC FieldValueLanguage
dc.contributor.authorYeung, F-
dc.contributor.authorFung, ACH-
dc.contributor.authorChung, PHY-
dc.contributor.authorWong, KKY-
dc.date.accessioned2020-04-03T07:23:23Z-
dc.date.available2020-04-03T07:23:23Z-
dc.date.issued2019-
dc.identifier.citationSurgical Endoscopy, 2019, Epub 2019-07-24-
dc.identifier.issn0930-2794-
dc.identifier.urihttp://hdl.handle.net/10722/281900-
dc.descriptioneid_2-s2.0-85069712663link_to_subscribed_fulltext-
dc.description.abstractBackground: Choledochal cysts are congenital dilations of the biliary tree. Complete cyst excision and biliary-enteric reconstruction have been the standard operations. In our center, more than 95% of choledochal cyst excision is now performed laparoscopically. Majority of current studies describe laparoscopic-assisted reconstruction using Roux-en-Y hepaticojejunostomy (HJ). However, only a few have studied laparoscopic hepaticoduodenostomy (HD) as an alternative method of biliary-enteric reconstruction. In this study, we focused on comparing longer-term outcomes between laparoscopic HJ and HD reconstruction following choledochal cyst excision. Methods: We performed retrospective analysis of 54 children who had undergone laparoscopic choledochal cyst excision and biliary-enteric reconstruction between October 2004 and April 2018. Short-term outcomes including operative time, complications such as anastomotic leakage and bleeding, and hospital stays were included. Long-term outcomes including contrast reflux into biliary tree, cholangitis, anastomotic strictures, and need of reoperation were analyzed. Results: Of the 54 patients, 21 of them underwent laparoscopic HD and 33 underwent laparoscopic Roux-en-Y HJ anastomosis reconstruction. There were no significant differences in gestation, gender, age at operation, antenatal diagnosis, and Todani type of choledochal cyst between HD and HJ group. Operative time was significantly shortened in HD group (p = 0.001). Median time to enteral feeding was 3 days in both groups. Median intensive care unit (p = 0.001) and hospital stay (p = 0.019) were significantly shorter in HD group. There was no perioperative mortality. There was no significant difference in anastomotic leakage requiring reoperation (p = 0.743). There were no significant differences in long-term outcomes including anastomotic stricture (p = 0.097), cholangitis (p = 0.061), symptoms of recurrent abdominal pain or gastritis (p = 0.071), or need of reoperation (p = 0.326). All patients had normal postoperative serum bilirubin level. Conclusions: Laparoscopic excision of choledochal cyst with HD reconstruction is safe and feasible with better short-term outcomes and comparable long-term outcomes compared to Roux-en-Y HJ reconstruction.-
dc.languageeng-
dc.publisherSpringer New York LLC. The Journal's web site is located at http://link.springer-ny.com/link/service/journals/00464/-
dc.relation.ispartofSurgical Endoscopy-
dc.rightsThis is a post-peer-review, pre-copyedit version of an article published in [insert journal title]. The final authenticated version is available online at: http://dx.doi.org/[insert DOI]-
dc.subjectLaparoscopic biliary-enteric reconstruction-
dc.subjectHepaticoduodenostomy-
dc.subjectHepaticojejunostomy-
dc.subjectCholedochal cyst-
dc.subjectLong-term outcomes-
dc.titleShort-term and long-term outcomes after Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy following laparoscopic excision of choledochal cyst in children-
dc.typeArticle-
dc.identifier.emailChung, PHY: chungphy@hku.hk-
dc.identifier.emailWong, KKY: kkywong@hku.hk-
dc.identifier.authorityChung, PHY=rp02002-
dc.identifier.authorityWong, KKY=rp01392-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s00464-019-07004-5-
dc.identifier.scopuseid_2-s2.0-85069712663-
dc.identifier.hkuros309653-
dc.identifier.volumeEpub 2019-07-24-
dc.publisher.placeUnited States-

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