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Factors predicting surgical difficulties in congenital biliary dilatation in pediatric patients
Masaki Honda1,2, Naoki Shimojima3, Yutaro Maeda1
1Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
Insights
Predicting surgical difficulty in pediatric congenital biliary dilatation (CBD) laparotomy is crucial. Maximum cyst diameter, preoperative AST, and bile duct anastomosis diameter are key indicators of operative time in CBD surgery.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Surgical Outcomes Research
Background:
- The difficulty of pediatric congenital biliary dilatation (CBD) laparotomy is not fully understood.
- Preoperative patient condition and disease classification impact surgical complexity.
Purpose of the Study:
- To identify predictors of operative time in pediatric CBD laparotomy.
- To elucidate factors influencing surgical difficulty in CBD surgery.
Main Methods:
- Retrospective analysis of 46 pediatric CBD laparotomies (March 2010 - December 2021).
- Patients categorized into short (≤360 min) and long (>360 min) operative time groups.
- Correlation and multivariate analyses to identify operative time predictors.
Main Results:
- Higher preoperative AST, ALT, and larger bile duct anastomosis diameter were noted in the long operative time group.
- Maximum cyst diameter, preoperative neutrophil-to-lymphocyte ratio, AST, ALT, AMY, and bile duct anastomosis diameter correlated with operative time.
- Maximal cyst diameter, preoperative AST, and bile duct anastomosis diameter were significant predictors of surgical time.
Conclusions:
- Maximum cyst diameter, preoperative AST, and bile duct anastomosis diameter can predict pediatric CBD laparotomy difficulty.
- These factors offer valuable insights for surgical planning and risk assessment in CBD cases.
Background:
The effects of disease classification and the patient's preoperative condition on the difficulty of performing a laparotomy for pediatric congenital biliary dilatation (CBD) have not been fully elucidated.
Methods:
The present study retrospectively analyzed 46 pediatric CBD laparotomies performed at the study center between March 2010 and December 2021 and predictors of operative time. The patients were separated into a short operative time group (SOT) (≤ 360 min, n = 27) and a long operative time group (LOT) (> 360 min, n = 19).
Results:
The preoperative AST and ALT values were higher, and the bile duct anastomosis diameter was larger, in the LOT. Correlation analysis demonstrated that the maximum cyst diameter, preoperative neutrophil-to-lymphocyte ratio, AST, ALT, AMY, and bile duct anastomosis diameter correlated positively with operative time. Multivariate analysis identified the maximal cyst diameter, preoperative AST, and bile duct anastomosis diameter as significant factors affecting surgical time. Postoperatively, intrapancreatic stones and paralytic ileus were observed in one patient each in the SOT, and mild bile leakage was observed in one patient in the LOT.
Conclusions:
The maximum cyst diameter, preoperative AST, and bile duct anastomosis diameter have the potential to predict the difficulty of performing a pediatric CBD laparotomy.
