Abstract
Standard reconstruction after choledochal cyst excision is by Roux-en-Y hepaticojejunostomy to the common hepatic duct. Long-term follow up studies have shown a 10% incidence of late complications, including anastomotic stricture. By extending the bilio-enteric anastomosis along the left hepatic duct, a wide hilar bilio-enteric anastomosis is created which may help to minimize late anastomotic complications. Forty-one consecutive patients (24 girls, 18 infants) with a median age of 2.3 years (range 44 days to 15.6 years) and median weight 11.5 kg (range 2.1–59 kg) underwent radical choledochal cyst excision with a wide hilar hepticojejunostomy. Thirty-eight were followed-up both clinically and by ultrasound scan and biochemical liver function tests for a median of 2.7 years (range 0.1–12.5 years). The median width of the hilar hepaticojejunostomy was 8 mm (range 6–25 mm) in 18 infants, and 15 mm (range 10–25 mm) in 22 older children. In one patient it was not measured. Only one surgical complication occurred—a self-limiting bile leak which settled spontaneously. Median postoperative stay was 6 days (range 5–21 days). No patient has had an episode of cholangitis or adhesive small bowel obstruction to date. Postoperative biochemical liver function tests have remained normal in all but one child (with pre-existing biliary cirrhosis). After radical resection of a choledochal cyst, a wide hilar hepaticojejunostomy is a, safe, effective and durable reconstructive technique that can be performed at any age and may help to minimize the long-term risk of complications.
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Tan KC, Howard ER (1988) Choledochal cyst: a 14-year surgical experience with 36 patients. Br J Surg 75:892–895
Joseph VT (1990) Surgical techniques and long-term results in the treatment of choledochal cyst. J Pediatr Surg 25:782–787
Todani T, Watanabe Y, Urushihara N et al (1995) Biliary complications after excisional procedure for choledochal cyst. J Pediatr Surg 30:478–481
Miyano T (2006) Choledochal cyst. In: Stringer MD, Oldham KT, Mouriquand PDE (eds) Pediatric surgery and urology: long term outcomes. 2nd edn. Cambridge University Press, New York
Saing H, Han H, Chan K et al (1997) Early and late results of excision of choledochal cysts. J Pediatr Surg 32:1563–1566
Hepp J, Couinaud C (1956) L’abord et l’utilisation du canal hépatique gauche dans les réparations de la voie biliaire principale. Presse Med 64:947–948
Hepp J (1985) Hepaticojejunostomy using the left biliary trunk for iatrogenic biliary lesions: the French connection. World J Surg 9:507–511
Stringer MD (2006) Choledochal cyst. In: Spitz L, Coran AG (eds) Operative pediatric surgery. 6th edn. Hodder Arnold, London, pp 673–682
Lilly JR, Stellin GP, Karrer FM (1985) Formefruste choledochal cyst. J Pediatr Surg 20:4451
Todani T (1998) Choledochal cysts. In: Stringer MD, Oldham KT, Mouriquand PDE, Howard ER (eds) Pediatric surgery and urology: long-term outcomes. WB Saunders Co., Philadelphia, pp 417–429
Takada K, Hamada Y, Watanabe K et al (2005) Duodenogastric reflux following biliary reconstruction after excision of choledochal cyst. Pediatr Surg Int 21:1–4
Shimotakahara A, Yamataka A, Yanai T et al (2005) Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: which is better? Pediatr Surg Int 21:5–7
Yamataka A, Ohshiro K, Okada Y et al (1997) Complications after cyst excision with hepaticoenterostomy for choledochal cysts and their surgical management in children versus adults. J Pediatr Surg 32:1097–1102
Lilly JR (1979) Surgery of coexisting biliary malformations in choledochal cyst. J Pediatr Surg 14:643–647
Todani T, Watanabe Y, Mizuguchi T, Fujii T, Toki A (1981) Hepaticoduodenostomy at the hepatic hilum after excision of choledochal cyst. Am J surg 142:584–587
Myburgh JA (1994) Surgical biliary drainage in primary sclerosing cholangitis: the role of the Hepp-Couinaud approach. Arch Surg 129:1057–1062
Li L, Feng W, Jing-Bo F et al (2004) Laparoscopic-assisted total cyst excision of choledochal cyst and Roux-en-Y hepatoenterostomy. J Pediatr Surg 39:1663–1666
Acknowledgments
I wish to thank my colleagues in pediatric hepatology, Dr. Paddy McLean, Dr. Suzanne Davison, and Dr. Sanjay Rajwal, for their contribution to the clinical care of these patients.
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Stringer, M.D. Wide hilar hepatico-jejunostomy: the optimum method of reconstruction after choledochal cyst excision. Pediatr Surg Int 23, 529–532 (2007). https://doi.org/10.1007/s00383-007-1929-3
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DOI: https://doi.org/10.1007/s00383-007-1929-3