Biliary reconstruction after choledochal cyst resection: a systematic review and meta-analysis on hepaticojejunostomy vs hepaticoduodenostomy
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In brief
In brief
Systematic review comparing two biliary reconstruction techniques after choledochal cyst excision in pediatric patients. Hepaticoduodenostomy shows advantages in operative time, blood loss, and hospital stay compared to hepaticojejunostomy, but has higher biliary reflux rates. Complication rates including leak and cholangitis are similar between approaches.
Written by the GCMD Library team from the article.
Abstract
Choledochal cysts are a rare pediatric biliary pathology. Excision of the extrahepatic cyst and restoration of biliary-enteric continuity through either hepaticoduodenostomy (HD) or Roux-en-Y hepaticojejunostomy (HJ) is the mainstay treatment. This study aims to determine if either method provides an advantage. Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing hepaticojejunostomy to hepaticoduodenostomy in patients with choledochal cysts. Data were analyzed using Review Manager 5.3. Nine studies were included, operative time was shorter − 97.50 [− 172.31, − 22.69] p = 0.01 and bleeding reduced − 48.98 [− 88.25, − 9.71] p = 0.01 in HD. HD was associated with shorter length of stay 2.18 [− 3.87, − 0.50] p = 0.01 and similar cholangitis and reintervention rates. Time to a normal diet was similar between groups. Biliary reflux was seen more frequently in HD 19.14 [2.60, 140.63] p = 0.004. Complications such as leak and cholangitis were similar between groups. HD represents a viable alternative to HJ with various advantages such as shorter operative time, decreased bleeding and shorter length of hospital stay. Bile reflux remains a major limitation.
Level of evidence IV.