Skip to main content
Erschienen in: Pediatric Surgery International 1/2005

01.01.2005 | Original Article

Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: which is better?

verfasst von: Akihiro Shimotakahara, Atsuyuki Yamataka, Toshihiro Yanai, Hiroyuki Kobayashi, Tadaharu Okazaki, Geoffrey J. Lane, Takeshi Miyano

Erschienen in: Pediatric Surgery International | Ausgabe 1/2005

Einloggen, um Zugang zu erhalten

Abstract

We reviewed our experience of Roux-en-Y hepaticojejunostomy (RYHJ) and hepaticoduodenostomy (HD) performed for the surgical repair of choledochal cyst (CC), with special emphasis on postoperative complications related to the type of biliary reconstruction performed. Eighty-six patients underwent primary cyst excision for CC from 1986 to 2002 at our institution. Forty-six cases with concurrent intrahepatic bile duct dilatation (IHBD) were excluded because HD was not used for biliary reconstruction if IHBD was present. Thus, 28 cases had RYHJ, and 12 had HD. Differences between the RYHJ and HD groups with respect to type of CC, age at cyst excision, and length of follow-up were not statistically significant. However, the incidences of postoperative complications related to biliary reconstruction, such as endoscopy-proven bilious gastritis due to duodenogastric bile reflux [4/12 (33.3%) of the HD group], and adhesive bowel obstruction/cholangitis [2/28 (7.1%) of the RYHJ group] were significantly different (p<.05). Our experience suggests that HD is not ideal for biliary reconstruction in CC because of a high incidence (33.3%) of complications due to duodenogastric bile reflux. Currently, RYHJ is our exclusive technique of choice for biliary reconstruction during the surgical repair of CC.
Literatur
1.
Zurück zum Zitat Miyano T, Yamataka A, Kato Y, Segawa O, Lane G, Takamizawa S, Kohno S, Fujiwara T (1996) Hepaticoenterostomy after excision of choledochal cyst in children: a 30-year experience with 180 cases. J Pediatr Surg 31:1417–1421CrossRefPubMed Miyano T, Yamataka A, Kato Y, Segawa O, Lane G, Takamizawa S, Kohno S, Fujiwara T (1996) Hepaticoenterostomy after excision of choledochal cyst in children: a 30-year experience with 180 cases. J Pediatr Surg 31:1417–1421CrossRefPubMed
2.
Zurück zum Zitat Yamataka A, Kobayashi H, Shimotakahara A, Okada Y, Yanai T, Lane GJ, Urao M, Miyano T (2003) Recommendations for preventing complications related to Roux-en-Y hepatico-jejunostomy performed during excision of choledochal cyst in children. J Pediatr Surg 38:1830–1832CrossRefPubMed Yamataka A, Kobayashi H, Shimotakahara A, Okada Y, Yanai T, Lane GJ, Urao M, Miyano T (2003) Recommendations for preventing complications related to Roux-en-Y hepatico-jejunostomy performed during excision of choledochal cyst in children. J Pediatr Surg 38:1830–1832CrossRefPubMed
3.
Zurück zum Zitat Todani T, Watanabe Y, Mizuguchi T, Fujii T, Toki A (1981) Hepaticoduodenostomy at the hepatic hilum after excision of choledochal cyst. Am J Surg 142:584–587CrossRefPubMed Todani T, Watanabe Y, Mizuguchi T, Fujii T, Toki A (1981) Hepaticoduodenostomy at the hepatic hilum after excision of choledochal cyst. Am J Surg 142:584–587CrossRefPubMed
4.
Zurück zum Zitat Rao KLN, Mitra SK, Kochher R, Thapa BR, Nagi B, Katariya S, Mehta S, Mehta SK (1987) Jejunal interposition hepaticoduodenostomy for choledochal cyst. Am J Gastroenterol 82:1042–1045PubMed Rao KLN, Mitra SK, Kochher R, Thapa BR, Nagi B, Katariya S, Mehta S, Mehta SK (1987) Jejunal interposition hepaticoduodenostomy for choledochal cyst. Am J Gastroenterol 82:1042–1045PubMed
5.
Zurück zum Zitat O’Neill JA Jr (1992) Choledochal cyst. Curr Probl Surg 29:365–410CrossRef O’Neill JA Jr (1992) Choledochal cyst. Curr Probl Surg 29:365–410CrossRef
6.
Zurück zum Zitat Ohi R, Yaoita S, Kamiyama T, Ibrahim M, Hayashi Y, Chiba T (1990) Surgical treatment of congenital dilatation of the bile duct with special reference to late complications after total excisional operation. J Pediatr Surg 25:613–617CrossRefPubMed Ohi R, Yaoita S, Kamiyama T, Ibrahim M, Hayashi Y, Chiba T (1990) Surgical treatment of congenital dilatation of the bile duct with special reference to late complications after total excisional operation. J Pediatr Surg 25:613–617CrossRefPubMed
7.
Zurück zum Zitat Todani T, Watanabe Y, Urushihara N, Noda T, Morotomi Y (1995) Biliary complications after excisional procedure for choledochal cyst. J Pediatr Surg 30:478–481CrossRefPubMed Todani T, Watanabe Y, Urushihara N, Noda T, Morotomi Y (1995) Biliary complications after excisional procedure for choledochal cyst. J Pediatr Surg 30:478–481CrossRefPubMed
8.
Zurück zum Zitat Todani T, Watanabe Y, Toki A, Hara H (2002) Hilar duct carcinoma developed after cyst excision followed by hepaticoduodenostomy. In: Koyanagi Y, Aoki T (eds) Pancreaticobiliary maljunction. Igaku tosho shuppan, Tokyo, pp 17–21 Todani T, Watanabe Y, Toki A, Hara H (2002) Hilar duct carcinoma developed after cyst excision followed by hepaticoduodenostomy. In: Koyanagi Y, Aoki T (eds) Pancreaticobiliary maljunction. Igaku tosho shuppan, Tokyo, pp 17–21
9.
Zurück zum Zitat Todani T, Watanabe Y, Toki A, Urushihara N, Sato Y (1988) Reoperation for congenital choledochal cyst. Ann Surg 207:142–147PubMed Todani T, Watanabe Y, Toki A, Urushihara N, Sato Y (1988) Reoperation for congenital choledochal cyst. Ann Surg 207:142–147PubMed
10.
Zurück zum Zitat Yamataka A, Ohshiro K, Okada Y, Hosoda Y, Fujiwara T, Kohno S, Sunagawa M, Futagawa S, Sakakibara N, Miyano T (1997) Complications after cyst excision with hepaticoenterostomy for choledochal cysts and their surgical management in children versus adults. J Pediatr Surg 32:1097–1102CrossRefPubMed Yamataka A, Ohshiro K, Okada Y, Hosoda Y, Fujiwara T, Kohno S, Sunagawa M, Futagawa S, Sakakibara N, Miyano T (1997) Complications after cyst excision with hepaticoenterostomy for choledochal cysts and their surgical management in children versus adults. J Pediatr Surg 32:1097–1102CrossRefPubMed
11.
Zurück zum Zitat Hara H, Morita S, Ishibashi T, Sako S, Otani M, Tanigawa N (2001) Surgical treatment for congenital biliary dilatation, with or without intrahepatic bile duct dilatation. Hepatogastroenterology 48:638–641PubMed Hara H, Morita S, Ishibashi T, Sako S, Otani M, Tanigawa N (2001) Surgical treatment for congenital biliary dilatation, with or without intrahepatic bile duct dilatation. Hepatogastroenterology 48:638–641PubMed
12.
Zurück zum Zitat Lopez RR, Pinson CW, Campbell JR, Harrison M, Katon RM (1991) Variation in management based on type of choledochal cyst. Am J Surg 161:612–615CrossRefPubMed Lopez RR, Pinson CW, Campbell JR, Harrison M, Katon RM (1991) Variation in management based on type of choledochal cyst. Am J Surg 161:612–615CrossRefPubMed
13.
Zurück zum Zitat Schdamore CH, Hemming AW, Teare JP, Fache JS, Erb SR, Watkinson AF (1994) Surgical management of choledochal cysts. Am J Surg 167:497–500CrossRefPubMed Schdamore CH, Hemming AW, Teare JP, Fache JS, Erb SR, Watkinson AF (1994) Surgical management of choledochal cysts. Am J Surg 167:497–500CrossRefPubMed
14.
Zurück zum Zitat Saing H, Han H, Chan KL, Lam W, Chan FL, Cheng W, Tam PKH (1997) Early and late results of excision of choledochal cysts. J Pediatr Surg 32:1563–1566CrossRefPubMed Saing H, Han H, Chan KL, Lam W, Chan FL, Cheng W, Tam PKH (1997) Early and late results of excision of choledochal cysts. J Pediatr Surg 32:1563–1566CrossRefPubMed
15.
Zurück zum Zitat Klarfeld J, Resnick G (1979) Gastric remnant carcinoma. Cancer 44:1129–1133PubMed Klarfeld J, Resnick G (1979) Gastric remnant carcinoma. Cancer 44:1129–1133PubMed
16.
Zurück zum Zitat Zuerlein N, Denzler T, Schenken JR (1985) Cancer arising in the gastric stump. Arch Pathol Lab Med 109:958–960PubMed Zuerlein N, Denzler T, Schenken JR (1985) Cancer arising in the gastric stump. Arch Pathol Lab Med 109:958–960PubMed
17.
Zurück zum Zitat Tanigawa H, Uesugi H, Mitomi H, Saigenji k, Okayasu I (2000) Possible association of active gastritis, featuring accelerated cell turnover and p53 overexpression, with cancer development at anastomoses after gastrojejunostomy. Am J Clin Pathol 114:354–363PubMed Tanigawa H, Uesugi H, Mitomi H, Saigenji k, Okayasu I (2000) Possible association of active gastritis, featuring accelerated cell turnover and p53 overexpression, with cancer development at anastomoses after gastrojejunostomy. Am J Clin Pathol 114:354–363PubMed
18.
Zurück zum Zitat Takada K, Hamada Y, Watanabe K, Tokuhara K, Tanano A, Ueyama Y (2004) [Tandoukakuchousyou jutsugo niokeru inai tanjyu gyakuryu no kentou (A study of duodeno-gastric reflux after choledochal cyst operation)]. Presented at the 41st annual meeting of the Japanese Society of Pediatric Surgeons, Osaka, June 2–4, 2004 Takada K, Hamada Y, Watanabe K, Tokuhara K, Tanano A, Ueyama Y (2004) [Tandoukakuchousyou jutsugo niokeru inai tanjyu gyakuryu no kentou (A study of duodeno-gastric reflux after choledochal cyst operation)]. Presented at the 41st annual meeting of the Japanese Society of Pediatric Surgeons, Osaka, June 2–4, 2004
19.
Zurück zum Zitat McArthur MS, Longmire WP Jr (1971) Peptic ulcer disease after choledochojejunostomy. Am J Surg 122:155–158CrossRefPubMed McArthur MS, Longmire WP Jr (1971) Peptic ulcer disease after choledochojejunostomy. Am J Surg 122:155–158CrossRefPubMed
Metadaten
Titel
Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: which is better?
verfasst von
Akihiro Shimotakahara
Atsuyuki Yamataka
Toshihiro Yanai
Hiroyuki Kobayashi
Tadaharu Okazaki
Geoffrey J. Lane
Takeshi Miyano
Publikationsdatum
01.01.2005
Verlag
Springer-Verlag
Erschienen in
Pediatric Surgery International / Ausgabe 1/2005
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-004-1252-1

Weitere Artikel der Ausgabe 1/2005

Pediatric Surgery International 1/2005 Zur Ausgabe

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.