M Li1, Q Jin, J Feng. 1. Department of Surgery, Children's Hospital, College of Medical Sciences, Zhejiang University, Hangzhou 310003, China.
Abstract
OBJECTIVE: To study the early postoperative complications of choledochal cyst excision with reconstruction of the biliary tract. METHODS: In last 10 years, 173 patients aged from 27 days to 14 years (mean = 2.4 years) were operated on with procedures of choledochal cyst excision and biliary tract reconstruction by jejunointerposition between the liver hilum and duodenum or Roux-en-Y hepaticojejunostomy in our hospital. Amongst these 173 patients, 16 were found to suffer from postoperative complications. Therefore, their clinical data were retrospectively analyzed, and the prevention and treatment of the early postoperative complications discussed. RESULTS: The morbidity of early postoperative complications was 9.3% (16/173). The early complications included biliary leakage in 10 patients, wound dehiscence of abdominal wall in 3, hepatic failure in 1, pancreatic fistula in 1, and postoperative enteric intussusception in 1. The morbidity of early postoperative complications in infants younger than 1-year old was significantly higher than that in children(chi 2 = 15.78, P < 0.01). However, there was no significant difference in the morbidity of early postoperative complications between patients undergoing biliary tract reconstruction by jejunal segment interposition and those undergoing that by Roux-en-Y hepaticojejunostomy (chi 2 = 0.07, P > 0.05). The total mortality in all the operated patients was 2.3% (4/173). Three patients died from biliary leakage and 1 from postoperative hepatic failure. CONCLUSIONS: Biliary leakage, wound dehiscence of abdominal wall and hepatic failure are major early postoperative complications. The morbidity in infants younger than 1-year old is higher than in children. The preoperative treatment of biliary tract infection, hypohepatia, and surgical skills during operation should be emphasized. Reoperation for biliary leakage should not be delayed and mycotic cholangitis after biliary leakage needs more attention. Tension suture in the fascial space of the abdominal wall is useful for the prevention and treatment of abdominal wall dehiscence.
OBJECTIVE: To study the early postoperative complications of choledochal cyst excision with reconstruction of the biliary tract. METHODS: In last 10 years, 173 patients aged from 27 days to 14 years (mean = 2.4 years) were operated on with procedures of choledochal cyst excision and biliary tract reconstruction by jejunointerposition between the liver hilum and duodenum or Roux-en-Y hepaticojejunostomy in our hospital. Amongst these 173 patients, 16 were found to suffer from postoperative complications. Therefore, their clinical data were retrospectively analyzed, and the prevention and treatment of the early postoperative complications discussed. RESULTS: The morbidity of early postoperative complications was 9.3% (16/173). The early complications included biliary leakage in 10 patients, wound dehiscence of abdominal wall in 3, hepatic failure in 1, pancreatic fistula in 1, and postoperative enteric intussusception in 1. The morbidity of early postoperative complications in infants younger than 1-year old was significantly higher than that in children(chi 2 = 15.78, P < 0.01). However, there was no significant difference in the morbidity of early postoperative complications between patients undergoing biliary tract reconstruction by jejunal segment interposition and those undergoing that by Roux-en-Y hepaticojejunostomy (chi 2 = 0.07, P > 0.05). The total mortality in all the operated patients was 2.3% (4/173). Three patients died from biliary leakage and 1 from postoperative hepatic failure. CONCLUSIONS: Biliary leakage, wound dehiscence of abdominal wall and hepatic failure are major early postoperative complications. The morbidity in infants younger than 1-year old is higher than in children. The preoperative treatment of biliary tract infection, hypohepatia, and surgical skills during operation should be emphasized. Reoperation for biliary leakage should not be delayed and mycotic cholangitis after biliary leakage needs more attention. Tension suture in the fascial space of the abdominal wall is useful for the prevention and treatment of abdominal wall dehiscence.
Authors: Manuel Gigena; Hugo V Villar; Negar G Knowles; John T Cunningham; Erik K Outwater; Luis R Leon Journal: World J Gastroenterol Date: 2007-11-28 Impact factor: 5.742