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Pediatric Surgery International

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01.12.2023 | Original Article

Postoperative anastomotic stricture following excision of choledochal cyst: a systematic review and meta-analysis

verfasst von: Rina Tanaka, Hiroki Nakamura, Sakiko Yoshimoto, Tokiko Okunobo, Ryosuke Satake, Takashi Doi

Erschienen in: Pediatric Surgery International | Ausgabe 1/2023

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Abstract

Purpose

Postoperative anastomotic stricture (PAS) is a well-known complication after correcting choledochal cyst (CC). Although the exact cause of PAS is unknown, various risk factors, such as Todani classification type IV-A, hepaticoduodenostomy, and narrow anastomosis have been reported to be associated with PAS. As far as we know, there is no report with a cumulative analysis of such risk factors of PAS. This systematic review and meta-analysis aimed to investigate the risk factors of PAS following surgical correction of CC in children.

Methods

A systematic literature search for relevant articles was performed in four databases using the combinations of the following terms “Congenital biliary dilatation”, “Congenital choledochal cyst”, “Choledochal cyst”, “Stenosis”, “Stricture”, and “Complication” for studies published between 1973 and 2022. The relevant cohorts of PAS were systematically searched for clinical presentation and outcomes.

Results

The search strategy identified 795 reports. Seventy studies met the defined inclusion criteria, reporting a total of 206 patients with PAS. There is no prospective study in this search. The incidence of PAS was 2.1%. The proportion of Todani classification of the patient with PAS was higher in type IV-A with significant difference (2.0% in type I and 10.1% in type IV-A (p = 0.001)). Fourteen studies reported a comparison between hepaticojejunostomy and hepaticoduodenostomy. There was no significant difference between the two groups (p = 0.36). Four studies reported the diameter of the anastomosis at the primary surgery. The mean diameter was 12.5 mm. Nine studies reported a comparison between laparoscopic surgery and open surgery. Pooled odds ratio of PAS did not show a statistical difference (p = 0.29).

Conclusions

This study suggests that close careful follow-up is important in the patients with type IV-A of CC who underwent excision surgery, considering the possibility of PAS.

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Titel: Postoperative anastomotic stricture following excision of choledochal cyst: a systematic review and meta-analysis
verfasst von: Rina Tanaka
Hiroki Nakamura
Sakiko Yoshimoto
Tokiko Okunobo
Ryosuke Satake
Takashi Doi
Publikationsdatum: 01.12.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 1/2023
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-022-05293-x

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Postoperative anastomotic stricture following excision of choledochal cyst: a systematic review and meta-analysis

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