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Biliary Reconstruction with Hepaticoduodenostomy Versus Hepaticojejunostomy After Choledochal Cyst Resection: A
Nicholas Iglesias1, Carlos Theodore Huerta1, Royi Lynn1
1Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
Insights
Choledochal cysts (CCs) require surgical removal and reconstruction. Current evidence is inconclusive on whether hepaticoduodenostomy or hepaticojejunostomy offers superior outcomes for pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Anomalies
Background:
- Choledochal cysts (CCs) are congenital biliary ductal dilations, primarily affecting children under 10.
- Complete surgical excision and reconstruction are the standard treatments for CCs.
Purpose of the Study:
- To compare hepaticoduodenostomy and hepaticojejunostomy for CC reconstruction.
- To evaluate anatomic, operative, and clinical outcomes of both surgical approaches.
Main Methods:
- Narrative review of current literature.
- Evaluation of perioperative, postoperative, and long-term outcomes.
- Analysis of anatomic and operative considerations.
Main Results:
- Evidence comparing hepaticoduodenostomy and hepaticojejunostomy for CCs is inconclusive regarding superior reconstruction.
- Further research is needed to clarify long-term comparative outcomes.
Conclusions:
- Complete surgical excision is essential for choledochal cysts.
- More comparative studies are required to determine the optimal reconstruction technique (hepaticoduodenostomy vs. hepaticojejunostomy) and minimize complications like biliary reflux and malignancy risk.
Abstract:
Choledochal cysts (CCs), a congenital anomaly resulting in the abnormal dilation of the biliary ductal system, are most often identified in patients younger than 10 years of age. Regardless of clinical presentation, the cornerstone of therapy for CCs is complete surgical excision with reconstruction with either hepaticoduodenostomy or hepaticojejunostomy. Although both procedures are used by surgeons for the correction of CCs, evidence on clinical outcomes following both approaches is inconclusive as to which may offer superior reconstruction. This narrative review aims to compare the current literature regarding both approaches by evaluating their anatomic and operative considerations, as well as their perioperative, postoperative, and long-term outcomes. Future studies should closely focus on long-term, comparative outcomes, including the risk of biliary malignancy, and refine techniques to minimize complications, such as biliary reflux and bowel obstruction, in order to improve care for pediatric patients undergoing treatment for CCs.
