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Updated: Apr 5, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Growth in children with choledochal malformations: effect of the Roux loop
Kathryn E Ford1, Lilli R L Cooper2, Mark Davenport3
1Department of Paediatric Surgery, King's College Hospital, London, SE5 9RS, UK.
Insights
Children with choledochal malformation (CM) experience growth failure before surgery. Post-operative Roux loop reconstruction leads to catch-up growth, indicating successful recovery from biliary obstruction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Biology
Background:
- Choledochal malformation (CM) is typically treated with excision and Roux loop biliary reconstruction.
- This surgical approach bypasses the duodenum and excludes a segment of the jejunum, raising concerns about its physiological impact.
- The effect of this reconstruction on post-operative growth in children has not been previously reported.
Purpose of the Study:
- To investigate the impact of Roux loop reconstruction on post-operative growth in children with choledochal malformation.
- To assess growth parameters before and after surgical correction of CM.
Main Methods:
- Retrospective analysis of medical records of pediatric patients (<16 years) surgically treated for CM between 1994 and 2014.
- Growth variables (height and weight) were converted to standard deviation scores (SDS) and compared to population norms.
- Statistical significance was determined using P < 0.05.
Main Results:
- 135 children were included, with median age at surgery of 3.3 years.
- Pre-operative growth failure was observed (median weight SDS = -0.4), correlating with elevated bilirubin, GGT, and AST levels.
- Following surgery, median follow-up of 1.9 years showed normalization of both height and weight SDS, indicating catch-up growth.
Conclusions:
- This study is the first to report on growth outcomes in children with CM after Roux loop reconstruction.
- Pre-operative growth failure is likely due to biliary obstruction, with significant catch-up growth observed post-operatively.
- Roux loop reconstruction appears to facilitate recovery of normal growth patterns in children with choledochal malformation.
Purpose:
Excision and biliary reconstruction using a Roux loop is the current standard for choledochal malformation (CM). This is un-physiological, delivering bile beyond the duodenum and excluding a significant length of the jejunum from intestinal absorption. We investigated whether this had an effect on post-operative growth.
Methods:
Retrospective case-note analysis of children surgically treated for CM. Growth variables were converted to standard deviation scores (SDS) and compared against population norms. P < 0.05 was significant.
Results:
From 1994 to 2014, 135 children (<16 years) were identified. Median age at surgery was 3.3 (IQR 1.5-7) years. Morphology included: type 1 Cystic (n = 54, 40%), type 1 Fusiform (n = 58, 43%) and type 4 (intra and extra-hepatic) (n = 22, 16%). There was pre-operative growth failure [median weight SDS = -0.4 (-1.2 - 0.4), P = 0.0004] with a similar trend for height [SDS = -0.38 (-1.2 - 0.5), P = 0.08)]. This correlated with presentation bilirubin (r s = -0.24, P = 0.004), GGT (r s = -0.27, P = 0.002) and AST (r s = -0.27, P = 0.002) but not morphology (P = 0.82) or presentation (P = 0.4). Median follow-up was 1.9 (0.6-4.7) years, during which time both height (P = 0.73) and weight (P = 0.45) reverted to normal.
Conclusion:
This is the first report of growth in children with CM following a Roux-loop reconstruction and showed pre-operative growth failure probably attributed to a period of biliary obstruction but catch-up growth when corrected.
