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Short- and intermediate-term evaluation of the initial definitive operation for perforated choledochal cysts compared to two-stage management

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Recently, single definitive hepaticojejunostomy has been proposed to replace two-stage procedures, including initial urgent biliary drainage and final biliary reconstruction, with a reduced hospitalization time and corresponding overall hospitalization cost. We aimed to investigate the safety and efficacy of the initial definitive operation compared with the two-stage approach.

Methods

The medical records of patients with perforated CDCs managed between 2010 and 2017 were retrospectively reviewed. The qualified samples were divided according to a single definitive operation or two-stage approach. We conducted a comparison of the clinical characteristics, including surgical parameters, length of stay, and short- and intermediate-term complications.

Results

A total of 117 patients with perforated CDCs were reviewed, with 48 cases of single-stage management and 69 cases of two-stage management. No differences in the baseline characteristics between the two groups were found, such as age, sex distribution, ultrasound presentation, or laboratory findings. The initial definitive operation was associated with a lower total duration of drainage, including abdominal drainage and biliary drainage (p < 0.001), and rate of unplanned readmission (OR, 0.056; 95% CI 0.007–0.435; p < 0.001) than those who underwent two-stage management. Furthermore, the initial definitive operation significantly reduced the postoperative hospital stay (p < 0.001), and the overall hospitalization cost was accordingly reduced compared with two-stage management (p < 0.001).

Conclusions

The initial single definitive operation was safe and effective for most of the patients with perforated CDCs when expertise was available. Therefore, a single definitive operation should be considered the treatment of choice for perforated CDCs.

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Acknowledgements

We thank Prof. Lei Li for providing technical assistance and for insightful discussions during the preparation of the manuscript. We thank Dr Xiaoyong Zhang at the Wistar Institute, USA, for help with the linguistic revision of the manuscript.

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Authors and Affiliations

  1. Department of Pediatric General Surgery, Children’s Hospital, Chongqing Medical University, Chongqing, 400014, People’s Republic of China

    Xu Wang & Kai Gao

  2. Department of Ultrasound, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, Chongqing, People’s Republic of China

    Chunbao Guo

  3. Department of Pediatric General Surgery, Chongqing Three Gorges Central Hospital, Chongqing, 400014, People’s Republic of China

    Chengwei Yan

  4. Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, People’s Republic of China

    Chunbao Guo

  5. Department of Pediatric General Surgery and Liver Transplantation, Children’s Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People’s Republic of China

    Chunbao Guo

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  1. Xu Wang
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Contributions

XW, FY and CG designed the study, analyzed the data and evaluated the manuscript. KG performed the statistical measurements and analyzed the data. CG and CY wrote the paper.

Corresponding author

Correspondence to Chunbao Guo.

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No potential conflicts of interest relevant to this article are reported.

Ethical approval

The research was supported by the National Natural Science Foundation of China (Nos: 30973440, 30770950) and the key project of the Chongqing Natural Science Foundation (CSTC, 2008BA0021, cstc2012jjA0155).

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Wang, X., Gao, K., Yan, C. et al. Short- and intermediate-term evaluation of the initial definitive operation for perforated choledochal cysts compared to two-stage management. Eur J Trauma Emerg Surg 48, 1129–1135 (2022). https://doi.org/10.1007/s00068-020-01553-4

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  • DOI: https://doi.org/10.1007/s00068-020-01553-4

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