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Is the appendix graft suitable for routine biliary surgery in children?
A Delarue1, J P Chappuis, C Esposito
1Service de Chirurgie Pédiatrique, Hôpital d'Enfants de la Timone, Marseille, France.
Journal of Pediatric Surgery
|September 22, 2000
Summary
Appendix grafting (AG) is not recommended for routine pediatric biliary reconstruction due to high rates of graft dysfunction and complications. AG should be reserved as a salvage technique, and patients require monitoring for cholestasis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatobiliary Surgery
Background:
- The appendix graft (AG) is commonly used for urinary tract reconstruction in children.
- Its application in biliary tract replacement is less frequent and its safety profile is not well-established.
Purpose of the Study:
- To evaluate the safety and efficacy of appendix grafting for biliary reconstruction in pediatric patients.
- To assess the long-term outcomes and complications associated with AG in biliary surgery.
Main Methods:
- Retrospective multicenter study reviewing 33 pediatric patients from 7 European centers.
- Indications included choledochal cyst (CC), biliary trauma (BT), and biliary atresia (BA).
- Graft insertion techniques varied based on indication: isoperistaltic for CC/BT, antiperistaltic for BA.
Main Results:
- Patients with CC and BT developed cholestasis within a year, requiring reoperation in 5 cases (4 converted to hepaticojejunostomy).
- Appendix grafting in biliary atresia patients showed poor outcomes, with 15% perioperative complications including graft necrosis and intestinal hemorrhage.
- Only 28% of biliary atresia patients achieved jaundice clearance.
Conclusions:
- Appendix grafting is unsuitable for routine pediatric biliary repair and should be a salvage option only when conventional hepaticojejunostomy is contraindicated.
- High risk of graft dysfunction necessitates screening for biochemical or histologic cholestasis in all patients who have undergone AG for biliary reconstruction.