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Published on: February 28, 2025
Application of Embedding Hepaticojejunostomy in Children with Pancreaticobiliary Maljunction Without Biliary
Fei Liu1, Menglong Lan1, Xiaogang Xu1
1Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Insights
Laparoscopic hepaticojejunostomy is a feasible treatment for children with pancreaticobiliary maljunction (PBM) without biliary dilatation. This minimally invasive approach demonstrated good patient outcomes and no long-term complications in a recent study.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Pancreaticobiliary maljunction (PBM) can present without biliary dilatation, making diagnosis challenging.
- Nondilated PBM often has concealed clinical manifestations, necessitating advanced diagnostic techniques.
- Surgical intervention is crucial for managing PBM to prevent complications.
Purpose of the Study:
- To evaluate the efficacy and safety of embedded hepaticojejunostomy in pediatric patients with nondilated PBM.
- To assess perioperative outcomes and long-term follow-up results of this surgical technique.
- To highlight the importance of preoperative diagnosis in managing PBM without biliary dilatation.
Main Methods:
- Retrospective analysis of clinical data from 10 pediatric patients with nondilated PBM.
- Diagnosis confirmed using magnetic resonance cholangiopancreatography (MRCP) and intraoperative cholangiography.
- Laparoscopic cholecystectomy, common bile duct resection, and embedded hepaticojejunostomy performed in all cases.
Main Results:
- Successful laparoscopic procedures with minimal blood loss (2-5 mL) and average operation time of 225 minutes.
- Patients showed rapid recovery with mean oral intake at 3.5 days and mean hospitalization of 6.2 days.
- Significant perioperative improvements in liver function indexes (P < .05) and no bile duct complications during a median 40-month follow-up.
Conclusions:
- Embedded hepaticojejunostomy is a feasible and effective surgical option for pediatric patients with nondilated PBM.
- Preoperative MRCP is vital for accurate diagnosis of PBM, especially in cases without biliary dilatation.
- The laparoscopic approach offers good short-term and long-term outcomes, promoting healthy growth in pediatric patients.
Abstract:
To investigate the effect of embedded hepaticojejunostomy in children with pancreaticobiliary maljunction (PBM) without biliary dilatation. The clinical data of 10 patients with nondilated PBM from February 2017 to July 2020 were retrospectively analyzed. Perioperative liver function indexes were compared. All patients were diagnosed by magnetic resonance cholangiopancreatography (MRCP) combined with intraoperative cholangiography. There were 5 cases of Komi type I and 5 cases of type II; the diameter of the common bile duct was 4-9 mm (median: 6 mm); and the length of the common channel was 5-15 mm (median: 9.25 mm). The procedure for one patient with common duct stones was converted to open surgery. Laparoscopic cholecystectomy, common bile duct resection, and embedded hepaticojejunostomy were successfully performed in all 10 cases. The average operation time was 225 ± 96.64 min, and the intraoperative blood loss was 2-5 mL. The mean time to oral intake was 3.5 ± 1.65 days (range: 2-5 days), and the mean hospitalization duration was 6.2 ± 2.44 days (range: 5-8 days). The differences in liver function indexes in the perioperative period were statistically significant (P < .05). The patients were followed-up for 13 to 54 months (median: 40 months). All patients grew well and there was no bile duct dilatation, calculus, or cirrhosis on B-ultrasound examinations. The clinical manifestations of nondilated PBM are often concealed, and preoperative MRCP was important for obtaining a diagnosis. Laparoscopic cholecystectomy, common bile duct resection, and embedded hepaticojejunostomy are feasible for treating nondilated PBM.
