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Published on: February 28, 2025
Coagulopathy in a subtype of choledochal cyst and management strategy
Mei Diao1, Long Li1, Wei Cheng1
1Mei Diao, Long Li, Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, China.
Insights
This study shows that a management algorithm effectively treats coagulopathy in children with congenital গণতান্ত্রিক disorders (CDC). Most children can undergo successful one-stage surgery, improving outcomes.
Area of Science:
- Pediatric Surgery
- Hematology
- Coagulopathy Management
Background:
- Coagulopathy is a significant challenge in pediatric patients with congenital গণতান্ত্রিক disorders (CDC).
- Effective management algorithms are crucial for optimizing surgical outcomes in these children.
Purpose of the Study:
- To evaluate a specific management algorithm for coagulopathy in children with CDC.
- To determine the efficacy of this algorithm in enabling one-stage definitive operations.
Main Methods:
- A cohort of 160 children with CDC and coagulopathy (fibrinogen < 2 g/L) were analyzed.
- The algorithm stratified treatment based on fibrinogen levels: 1-2 g/L for immediate surgery, < 1 g/L for medical treatment followed by surgery or drainage.
- External biliary drainage was used for liver function improvement in select cases.
Main Results:
- 92.5% of children with coagulopathy underwent successful one-stage definitive operations after preoperative optimization.
- The remaining 7.5% required initial external bile drainage before surgery.
- Operative times, recovery, and follow-up were comparable to children with normal coagulation, with no transfusions or complications.
Conclusions:
- The proposed management protocol successfully enables one-stage definitive operations for the majority of CDC children with coagulopathy.
- This algorithm improves surgical management and outcomes in this vulnerable pediatric population.
Aim:
To evaluated our management algorithm of the coagulopathy. We evaluated our management algorithm of the coagulopathy.
Methods:
Between October 2001 and January 2013, 160 CDC children with coagulopathy (fibrinogen, FIB < 2 g/L) were recruited. FIB ≥ 1 g/L is generally required for safe elective surgery. We used FIB level as an indicator when: (1) patients with FIB levels between 1-2 g/L underwent one-stage definitive operation; and (2) patients with FIB < 1 g/L underwent 3 d of medical treatment. Thereafter, those with FIB ≥ 1 g/L underwent one-stage definitive operation whereas those with FIB < 1 g/L underwent external biliary drainage to allow liver function improvement. Those patients with liver function improvements underwent definitive operation after 7 d of drainage.
Results:
After preoperative optimization, 92.5% of CDC children with coagulopathy underwent successful one-stage definitive operation. The remaining 7.5% of CDC children required initial external bile drainage, and underwent definitive operation 11 d after the admission. The mean operative time and postoperative recovery duration were comparable to those with normal coagulations. The median follow-up period was 57 mo. No blood transfusion or other postoperative complications were encountered.
Conclusion:
Following our management protocol, the majority of CDC children with coagulopathy can be managed with one-stage definitive operation.
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