Maria H A van den Eijnden1, Ruben H de Kleine2, Ivo de Blaauw3, Paul M J G Peeters2, Bart G P Koot4, Matthijs W N Oomen5, Cornelius E J Sloots6, Wim G van Gemert7, David C van der Zee8, L W Ernest van Heurn5, Henkjan J Verkade9, Jim C H Wilde10, Jan B F Hulscher11. 1. Department of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 2. Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 3. Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands. 4. Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands. 5. Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands. 6. Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands. 7. Department of Pediatric Surgery, University Medical Center Maastricht, Maastricht, The Netherlands. 8. Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 9. Department of Pediatrics, University of Groningen, University Medical Center Groningen, University of Groningen, The Netherlands. 10. University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland. 11. Department of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.b.f.hulscher@umcg.nl.
Abstract
INTRODUCTION: Choledochal malformations (CMs) are increasingly diagnosed antenatally. There is a dilemma between early surgery to prevent CM-related symptoms and postponing surgery to reduce complications. We aimed to identify the optimal timing of surgery in asymptomatic neonates with antenatally diagnosed CM and to identify predictors for development of symptoms. METHODS: Using the Netherlands Study group on CHoledochal Cyst/malformation (NeSCHoc) we retrospectively collected demographic, biochemical and surgical data from all Dutch patients with an antenatally detected CM. RESULTS: Between 1989 and 2014, antenatally suspected CM was confirmed in 17 patients at a median age of 10days (1day-2months). Four patients developed symptoms directly after birth (24%). Thirteen patients (76%) remained asymptomatic. Two of these progressed to symptoms before surgical intervention at 0.7 and 2.1months resp. Postoperatively, four patients developed short-term complications and three developed long-term complications. Patients <5.6kg (the series median) showed more short-term complications (66%) when compared to patients >5.6kg (0%, p=0.02). CONCLUSION: When not symptomatic within the first days of life, the majority of children with antenatally detected CM remains asymptomatic. Surgery might safely be delayed to the age of 6months or a weight of 6kg. Postponing surgery in the clinically and biochemical asymptomatic patient might decrease the complication rate. LEVELS OF EVIDENCE: Level III.
INTRODUCTION:Choledochal malformations (CMs) are increasingly diagnosed antenatally. There is a dilemma between early surgery to prevent CM-related symptoms and postponing surgery to reduce complications. We aimed to identify the optimal timing of surgery in asymptomatic neonates with antenatally diagnosed CM and to identify predictors for development of symptoms. METHODS: Using the Netherlands Study group on CHoledochal Cyst/malformation (NeSCHoc) we retrospectively collected demographic, biochemical and surgical data from all Dutch patients with an antenatally detected CM. RESULTS: Between 1989 and 2014, antenatally suspected CM was confirmed in 17 patients at a median age of 10days (1day-2months). Four patients developed symptoms directly after birth (24%). Thirteen patients (76%) remained asymptomatic. Two of these progressed to symptoms before surgical intervention at 0.7 and 2.1months resp. Postoperatively, four patients developed short-term complications and three developed long-term complications. Patients <5.6kg (the series median) showed more short-term complications (66%) when compared to patients >5.6kg (0%, p=0.02). CONCLUSION: When not symptomatic within the first days of life, the majority of children with antenatally detected CM remains asymptomatic. Surgery might safely be delayed to the age of 6months or a weight of 6kg. Postponing surgery in the clinically and biochemical asymptomatic patient might decrease the complication rate. LEVELS OF EVIDENCE: Level III.
Authors: Ruben H de Kleine; A Marthe Schreuder; Anneke Ten Hove; Jan B F Hulscher; Inne H M Borel Rinkes; Cornelis H C Dejong; Jeroen de Jonge; Philip de Reuver; Joris Erdmann; Geert Kazemier; Thomas M van Gulik; Annette S H Gouw; Robert J Porte Journal: Liver Int Date: 2020-08-03 Impact factor: 5.828