Abstract
Background: The aim of the current study was to investigate the cause and develop a management strategy for recurrent biliary obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cyst (CDC). Methods: Thirty CDC patients (mean age: 7.15 years, range 8 months–24 years, F/M: 22/8) who suffered from recurrent biliary obstructions after primary laparoscopic hepaticojejunostomies were referred to our hospital between January 2006 and June 2014. All patients underwent redo hepaticojejunostomy ± ductoplasty ± reposition of aberrant right hepatic arteries. Results: All patients developed recurrent cholangitis or persistent abnormal liver function 1 month to 7 years postoperatively. Liver biopsy pathology verified that 56.7 % (17/30) of patients had grades I–IV of liver fibrosis. We identified a previously unreported cause of biliary obstruction, i.e., aberrant right hepatic arteries crossing anteriorly to the proximal common hepatic duct in high percentage of the patients who suffered from postoperative recurrent biliary obstructions (7/30, 23.3 %). The hepatic arteries were repositioned behind Roux loop during the redo hepaticojejunostomies. Of remaining patients, nine (30 %) patients had associated hepatic duct strictures and underwent ductoplasties and wide hepaticojejunostomies. Fourteen (46.7 %) patients had anastomotic strictures and underwent redo hepaticojejunostomies. The median follow-up period was 62 months (14–115 months). No recurrent biliary obstruction or cholangitis was observed up to date. Liver functions were normalized. Conclusions: Aberrant hepatic artery, unsolved hepatic duct stricture, as well as poor anastomotic technique, can all contribute to recurrent biliary obstructions after the primary laparoscopic hepaticojejunostomies. Early surgical correction is advocated to minimize liver damage.
| Original language | English |
|---|---|
| Pages (from-to) | 3910-3915 |
| Number of pages | 6 |
| Journal | Surgical Endoscopy |
| Volume | 30 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 1 Sep 2016 |
Keywords
- Aberrant hepatic artery
- Children
- Choledochal cysts
- Hepaticojejunostomy
- Laparoscopy
- Postoperative recurrent biliary obstruction
Cite this
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Recurrence of biliary tract obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cysts. / Diao, Mei; Li, Long; Cheng, Wei.
In: Surgical Endoscopy, Vol. 30, No. 9, 01.09.2016, p. 3910-3915.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Recurrence of biliary tract obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cysts
AU - Diao, Mei
AU - Li, Long
AU - Cheng, Wei
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background: The aim of the current study was to investigate the cause and develop a management strategy for recurrent biliary obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cyst (CDC). Methods: Thirty CDC patients (mean age: 7.15 years, range 8 months–24 years, F/M: 22/8) who suffered from recurrent biliary obstructions after primary laparoscopic hepaticojejunostomies were referred to our hospital between January 2006 and June 2014. All patients underwent redo hepaticojejunostomy ± ductoplasty ± reposition of aberrant right hepatic arteries. Results: All patients developed recurrent cholangitis or persistent abnormal liver function 1 month to 7 years postoperatively. Liver biopsy pathology verified that 56.7 % (17/30) of patients had grades I–IV of liver fibrosis. We identified a previously unreported cause of biliary obstruction, i.e., aberrant right hepatic arteries crossing anteriorly to the proximal common hepatic duct in high percentage of the patients who suffered from postoperative recurrent biliary obstructions (7/30, 23.3 %). The hepatic arteries were repositioned behind Roux loop during the redo hepaticojejunostomies. Of remaining patients, nine (30 %) patients had associated hepatic duct strictures and underwent ductoplasties and wide hepaticojejunostomies. Fourteen (46.7 %) patients had anastomotic strictures and underwent redo hepaticojejunostomies. The median follow-up period was 62 months (14–115 months). No recurrent biliary obstruction or cholangitis was observed up to date. Liver functions were normalized. Conclusions: Aberrant hepatic artery, unsolved hepatic duct stricture, as well as poor anastomotic technique, can all contribute to recurrent biliary obstructions after the primary laparoscopic hepaticojejunostomies. Early surgical correction is advocated to minimize liver damage.
AB - Background: The aim of the current study was to investigate the cause and develop a management strategy for recurrent biliary obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cyst (CDC). Methods: Thirty CDC patients (mean age: 7.15 years, range 8 months–24 years, F/M: 22/8) who suffered from recurrent biliary obstructions after primary laparoscopic hepaticojejunostomies were referred to our hospital between January 2006 and June 2014. All patients underwent redo hepaticojejunostomy ± ductoplasty ± reposition of aberrant right hepatic arteries. Results: All patients developed recurrent cholangitis or persistent abnormal liver function 1 month to 7 years postoperatively. Liver biopsy pathology verified that 56.7 % (17/30) of patients had grades I–IV of liver fibrosis. We identified a previously unreported cause of biliary obstruction, i.e., aberrant right hepatic arteries crossing anteriorly to the proximal common hepatic duct in high percentage of the patients who suffered from postoperative recurrent biliary obstructions (7/30, 23.3 %). The hepatic arteries were repositioned behind Roux loop during the redo hepaticojejunostomies. Of remaining patients, nine (30 %) patients had associated hepatic duct strictures and underwent ductoplasties and wide hepaticojejunostomies. Fourteen (46.7 %) patients had anastomotic strictures and underwent redo hepaticojejunostomies. The median follow-up period was 62 months (14–115 months). No recurrent biliary obstruction or cholangitis was observed up to date. Liver functions were normalized. Conclusions: Aberrant hepatic artery, unsolved hepatic duct stricture, as well as poor anastomotic technique, can all contribute to recurrent biliary obstructions after the primary laparoscopic hepaticojejunostomies. Early surgical correction is advocated to minimize liver damage.
KW - Aberrant hepatic artery
KW - Children
KW - Choledochal cysts
KW - Hepaticojejunostomy
KW - Laparoscopy
KW - Postoperative recurrent biliary obstruction
UR - http://www.scopus.com/inward/record.url?scp=84949568973&partnerID=8YFLogxK
U2 - 10.1007/s00464-015-4697-5
DO - 10.1007/s00464-015-4697-5
M3 - Article
VL - 30
SP - 3910
EP - 3915
JO - Surgical Endoscopy
JF - Surgical Endoscopy
SN - 0930-2794
IS - 9
ER -