Nationwide Expert Survey on Appropriate Bile Duct Transection Line in Adult and Pediatric Congenital Biliary...

Resection of the extrahepatic bile duct including the gallbladder and the dilated segment, is a widely accepted surgical concept in congenital biliary dilatation (CBD) in both adult and pediatric surgeons. However, owing to the existence of various types of CBD and differences in the extent of dilatation, no consensus has been reached regarding the appropriate resection margins.

Consensus statements regarding the appropriate surgical margins for both the duodenal and hepatic hilum sides were developed as two clinical questions (CQs) during a multidisciplinary consensus meeting. A comprehensive literature review and expert survey were conducted. Consensus was achieved through a Delphi voting process, with statements approved when ≥ 75% agreement was reached.

In a nationwide expert survey, pediatric institutions resected the bile duct closer to the junction of the pancreatic duct on the duodenal side relative to adult institutions. In contrast, adult institutions aggressively transected higher levels of the hepatic duct on the hilum side. Taking literature reviews into account, the following consensus statement was developed: "The narrow segment is a good landmark to remove closely to the pancreatic junction on the duodenal side and the decision on the resection line on the hepatic hilum side should be dependent on the type of Todani's classification." This statement achieved a unanimous agreement in the Delphi vote.

It should be noted that there are differences in surgical concepts between adult and pediatric institutions. Further research is needed to determine the long-term outcomes related to the resection line.