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.
Similar content being viewed by others
References
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 31:1417–1421
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 38:1830–1832
Todani T, Watanabe Y, Mizuguchi T, Fujii T, Toki A (1981) Hepaticoduodenostomy at the hepatic hilum after excision of choledochal cyst. Am J Surg 142:584–587
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 82:1042–1045
O’Neill JA Jr (1992) Choledochal cyst. Curr Probl Surg 29:365–410
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 25:613–617
Todani T, Watanabe Y, Urushihara N, Noda T, Morotomi Y (1995) Biliary complications after excisional procedure for choledochal cyst. J Pediatr Surg 30:478–481
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, Urushihara N, Sato Y (1988) Reoperation for congenital choledochal cyst. Ann Surg 207:142–147
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 32:1097–1102
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 48:638–641
Lopez RR, Pinson CW, Campbell JR, Harrison M, Katon RM (1991) Variation in management based on type of choledochal cyst. Am J Surg 161:612–615
Schdamore CH, Hemming AW, Teare JP, Fache JS, Erb SR, Watkinson AF (1994) Surgical management of choledochal cysts. Am J Surg 167:497–500
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 32:1563–1566
Klarfeld J, Resnick G (1979) Gastric remnant carcinoma. Cancer 44:1129–1133
Zuerlein N, Denzler T, Schenken JR (1985) Cancer arising in the gastric stump. Arch Pathol Lab Med 109:958–960
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 114:354–363
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
McArthur MS, Longmire WP Jr (1971) Peptic ulcer disease after choledochojejunostomy. Am J Surg 122:155–158
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shimotakahara, A., Yamataka, A., Yanai, T. et al. Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: which is better?. Ped Surgery Int 21, 5–7 (2005). https://doi.org/10.1007/s00383-004-1252-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-004-1252-1