ABSTRACT
Background: Choledochal cyst is a congenital anomaly of the ducts of the extarhepaticbiliary tree. This condition is considered rare in the view of western population with an incidence of 1 in 100,000 to 150,000 births, while it defers in the Asian population where in the incidence is nearly 1 in 1000 live births. Aim: To compare and assess the advantages and disadvantages between the two standard procedures in the surgical management of choledochal cyst in children. Materials and methods: The required sample size was collected prospectively over a period of two years from November 2014 to October 2016. The decision for biliary-enteric anastomosis (Hepaticoduodenostomy Vs. Hepatico- jejunostomy) made was not influenced or directed by the study. The type of anastomosis was left to the surgeon’s personal preference in each case.15 cases of each type of biliary-enteric anastomosis – Hepatico-duodenostomy and Hepatico-jejunostomy were chosen. Results: The age distribution in cases undergoing hepatico-duodenostomy was almost near to equal, female to male ratio was of 1.25: 1. Out of 15 patients 5 in hepatico-duodenostomy group and 3 in hepatico-jejunostomy had a palpable mass in the right upper quadrant. This means that a palpable mass was seen in 26% of our patients who present for surgical correction of a CC. Second most important presenting complaint in CC was pain. Thirteen out of 30 children presented with bilious vomiting. On an average, we had initiation of feeds in the hepatico-duodenostomy group was of 5 K.V. Sathyanarayana, Sri Aparna Mummaneni. Comparative study of Hepatico-duodenostomy Vs. Hepatico-jejunostomy surgical procedures in the management of choledochal cyst in children. IAIM, 2018; 5(10): 127-137. Page 128 days and that of the hepatico-jejunostomy group was of 7 days. Average stay for the hepaticoduodenostomy group was around 7.6 days when compared to 10.5 days in the hepatico-jejunostomy group. One case in hepatico-jejunostomy group was seen to have bile leak on the 4 the post-operative day. No other early complications were seen in the hepatico-duodenostomy group. One child belonging to hepatio-duodenostomy group had been admitted three months post-operatively with the complaint of recurrent pain abdomen and fever. In cases of hepatico-duodenostomy, none of them presented with any symptoms of pain abdomen or recurrent vomiting. Conclusion: Our results also support HD as the preferred procedure for biliary reconstruction after resection of CC, in view of the advantages of relative simplicity, and low rate of complications.
ABSTRACT
Laparoscopic cholecystectomy is standard treatment for cholelithiasis. It associates with high incidents of complications when compared to open cholecystectomy. Most common complication is bile duct injuries associate with high morbidity. Normally, proximal ductal injuries are repaired by hepatico-jejunostomy since the incidence of stricture is more common with end-to-end anastomosis. We came across one such case of right hepatic duct injury where the right hepatic duct was completely transected. Immediate end-to-end primary anastomosis was done on a 5F feeding tube. Post-operativecholangiogram (CGM) showed minimal leak at the anastomotic site, displaying the normal proximal ductal system of right lobe. Patient was normal after following for 18 months. It is our opinion that primary anastomosis is preferable particularly when duct is larger in caliber as in our case it was admitting 5F feeding tube. Primary end-to-end anastomosis will reduce the morbidity form leak since chances of leak are more hepatico-jejunostomy and prevent possible ascending cholangitis.