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Published on: July 14, 2022
Long-term outcome for children undergoing open hepatico-jejunostomy for choledochal malformations: a 43-year
M V Stern1, G Boroni2,3, F Parolini2,3
1Department of Pediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy. mariavittoria.stern@gmail.com.
Insights
Surgical excision of choledochal malformations (CMs) in children yields excellent long-term outcomes and quality of life (QoL). However, late complications necessitate careful, long-term follow-up protocols for pediatric surgery patients.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Congenital Malformations
Background:
- Choledochal malformations (CMs) are rare congenital anomalies of the biliary tract.
- Long-term outcomes and quality of life (QoL) after surgical correction in pediatric patients require further investigation.
Purpose of the Study:
- To evaluate the long-term results and QoL in pediatric patients who underwent surgery for CMs.
- To analyze the incidence and timing of long-term postoperative complications (POCs) after CMs surgery.
Main Methods:
- Retrospective analysis of 113 pediatric patients with CMs treated between 1980 and 2022.
- Focus on long-term POCs (occurring ≥5 years post-surgery) and adult QoL assessment.
- Comparison of QoL with a matched control group.
Main Results:
- Open excision with Roux-en-Y hepaticojejunostomy (HJ) was performed in all patients.
- Median follow-up was 8.95 years; 8.9% experienced major long-term POCs, presenting a median of 11 years post-surgery.
- Adult QoL was comparable to controls; no biliary malignancies were observed.
Conclusions:
- Open complete excision of CMs with HJ provides excellent long-term results.
- Severe complications can manifest many years after surgery, highlighting the need for precise transitional care follow-up.
- International collaboration is recommended to establish standardized follow-up protocols for CMs patients.
Purpose:
To report on our 43-year single-center experience with children operated on for Choledochal Malformations (CMs), focusing on long-term results and Quality of life (QoL).
Materials And Methods:
All consecutive pediatric patients with CMs who underwent surgical treatment at our center between October 1980 and December 2022 were enrolled in this retrospective study. We focused on long-term postoperative complications (POCs), considered to be complications arising at least 5 years after surgery. We analyzed QoL status once patients reached adulthood, comparing the results with a control group of the same age and sex.
Results:
One hundred and thirteen patients underwent open excision of CMs with a Roux-en-Y hepaticojejunostomy (HJ). The median follow-up was 8.95 years (IQR: 3.74-24.41). Major long-term POCs occurred in six patients (8.9%), with a median presentation of 11 years after surgery. The oldest patient is currently 51. No cases of biliary malignancy were detected. The QoL of our patients was comparable with the control group.
Conclusion:
Our experience suggests that open complete excision of CMs with HJ achieves excellent results in terms of long-term postoperative outcomes. However, since the most severe complications can occur many years after surgery, international cooperation is advisable to define a precise transitional care follow-up protocol.
