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Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction after resection of congenital biliary dilatation: a systematic review and meta-analysis

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Abstract

The ideal surgical management for reconstruction after excision of congenital biliary dilatation remains controversial. This updated meta-analysis compared the clinical outcomes of hepaticoduodenostomy (HD) and hepaticojejunostomy (HJ) after resection of congenital biliary dilatation. PubMed, Web of Science, Embase, Ovid, and the Cochrane Library were searched for studies published from November 1981 through July 2020. The primary outcomes were the operative time, enteral feeding time, hospital stay, and postoperative complications. The quality and risk of bias were assessed with the Newcastle–Ottawa Quality Assessment Scale. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Thirteen total studies included 518 (55.76%) HD cases and 411 (44.24%) HJ cases. Five studies were published post-2013; one was a randomized clinical trial. Patients undergoing HD had a shorter hospital stay (MD, 0.40; p = 0.02) and operative time (MD, 59.54; p < 0.00001) and a lower incidence of adhesive intestinal obstruction (OR, 0.20; p = 0.02) than HJ. HD was comparable to conventional HJ with regard to most postoperative outcomes; however, it was associated with a higher incidence of postoperative bilious gastritis (OR, 6.24; p = 0.002). HD is as safe and feasible as HJ with better outcomes in the short run, although reports with long-term follow-up are relatively few. Long-term follow-up will be necessary to monitor possible associated malignancies in the future.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

The RevMan 5.4 statistical software program (updated by the Cochrane Library for Systematic Reviews) was used to pool the data, which generated forest plots, funnel plots, pooled odds ratios (ORs), pooled mean differences (MDs), and confidence intervals (CIs) in this study.

Abbreviations

CBD:

Congenital biliary dilatation

CI:

Confidence interval

HD:

Hepaticoduodenostomy

HJ:

Hepaticojejunostomy

MD:

Mean difference

MeSH:

Medical Subject Headings

NOS:

Newcastle–Ottawa Quality Assessment Scale

OR:

Odds ratio

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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  1. Chengbo Ai and Yang Wu contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Surgery, West China Hospital/West China School of Medicine, Sichuan University, #37 Guo-Xue-Xiang, Chengdu, 610041, People’s Republic of China

    Chengbo Ai, Yang Wu, Xiaolong Xie, Qi Wang & Bo Xiang

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  1. Chengbo Ai
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Contributions

CBA conceived the methodology of the study; performed the database search, article selection, and data extraction; performed the statistical analysis; drafted the manuscript. YW conceived the methodology of the study; performed the database search, article selection and data extraction; and drafted the manuscript. BX conceived the methodology of the study, helped with the data extraction process, and drafted the manuscript. XLX and QW helped draft the manuscript. All authors read and approved the manuscript.

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Correspondence to Bo Xiang.

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Ai, C., Wu, Y., Xie, X. et al. Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction after resection of congenital biliary dilatation: a systematic review and meta-analysis. Surg Today 53, 1–11 (2023). https://doi.org/10.1007/s00595-021-02425-z

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