Open Hepaticojejunostomy vs. Hepaticoduodenostomy for choledochal cyst in children,Which one is better?
Thanks.Now a days pediatric surgeons are doing hepaticodudenostomy more and publishing articles in favour of it as it is more physiological,less complications,less operating time,less hospital stay and easy to perform comparing with hepaticojejunostomy both open and laparoscopy. What do you think?
In the long history of choledochal cyst surgery roux en y hepaticojejunostomy was a clearly accepted procedure until laparoscopic excision was envisaged (am an ardent practitioner of advanced laparoscopy too) an hepaticoduodenostomy was explored due to its ease to be done laparoscopically. BUT is that sufficient reason to do the same- ease of a procedure and decreased operative time?
Several large studies have shown that complications are higher with hepatico duodenostomy with respect to cholangitis and bile reflux and gastritis when compared to hepaticojejunostomy.(miyano 2004, Nguyen2014)
Another important reason to avoid a hepatico duodenostomy is IF,(it rarely does but if the anastamoses leaks), in a HJ it is a minor matter, GI continuity is present and the child can continue to feed and with the nutrition preserved, leak eventually stops
But if HD then it is duodenal leak with all its trouble some problems, patient has to be nil by mouth/nil per oral, TPN to maintain nutrition, costs of the same in a developing nation setting and sepsis etc.
I personally feel the RISKS outweigh the benefits of HD and would do a Roux-n-Y hepatico jejunostomy for the reconstruction after a choledochal cyst excision.
sorry for the long post
Dear Dr.Samabanadan,
Many thanks for your reply.At our institute we are in debate which one would be our institutional practice,some one do comparative study(early out come) at our institution which shows HD is better & some refference articles from India,Egypt,USA,Vietnam in favour of HD given in the study.Though I am like to do HJ.
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