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One-staged or two-staged surgery for perforated choledochal cyst with bile peritonitis in children? A single center
Tran Ngoc Son1, Nguyen Thanh Liem, Vu Manh Hoan
1Surgical Department, National Hospital of Pediatrics, 18/879 La Thanh Road, Hanoi, 100000, Vietnam, drtranson@yahoo.com.
Insights
Pediatric perforated choledochal cyst with bile peritonitis (PCC) management evolved to favor one-staged definitive repair. This approach proved safe and effective in experienced centers, leading to good patient outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Perforated choledochal cyst with bile peritonitis (PCC) is a critical condition in children.
- Management strategies have historically varied, impacting patient outcomes.
Purpose of the Study:
- To evaluate the authors' experience managing pediatric PCC.
- To assess the efficacy and safety of surgical approaches for PCC.
Main Methods:
- Retrospective review of medical records for children treated for PCC between May 2005 and January 2013.
- Comparison of outcomes between two-staged and one-staged surgical repair.
Main Results:
- Twenty-seven pediatric patients with PCC were identified, with median age of 2 years.
- Clinical presentations included abdominal pain, distention, vomiting, and jaundice.
- A shift towards one-staged definitive repair since January 2008 resulted in no anastomotic leakage and good health upon discharge, with a mean postoperative stay of 7.6 days.
Conclusions:
- One-staged definitive repair is a feasible and safe treatment for pediatric PCC.
- This approach is recommended as the treatment of choice in experienced centers.
- Successful outcomes were observed with a median follow-up of 24 months.
Purpose:
To report the authors' experience in the management of perforated choledochal cyst with bile peritonitis (PCC) in children.
Methods:
Medical records of all children undergoing surgery for PCC at our hospital from May, 2005 to January, 2013 were reviewed.
Results:
Twenty seven patients were identified, with a median age of 2 years. The clinical manifestations were abdominal pain (96.3 %), abdominal distention (92.6 %), vomiting (88.9 %), jaundice (74.1 %), fever (70.4 %), acholic stool (51.8 %), abdominal tenderness (92.6 %), peritoneal signs (74.1 %), and palpable mass (18.5 %). Duration of the acute symptoms ranged from 1 to 30 days (median 3 days). Median size of the choledochal cysts was 3 cm (range 1.5-18 cm). Before January 2008, four cases were treated by two-staged surgery and only one case by one-staged surgery. Since then, all remaining 22 cases were treated by the one-staged surgery. There was no anastomotic leakage and all patients were discharged in good health. The mean postoperative stay was 7.6 ± 2.5 days for the one-staged group. No complication was noted at a median follow-up of 24 months.
Conclusions:
One-staged definitive repair is feasible, safe and should be the treatment of choice for most cases of childhood PCC in experienced centers.
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