Minilaparotomy in the treatment of choledochal malformations in children

Abstract

Introduction. The article presents the analysis of surgical treatment of children with choledochal malformations (CM) with mini-laparotomy and laparoscopy techniques.Purpose. The aim of the study is to improve outcomes of surgical treatment of choledochal malformations in children.Material and methods. For the last ten years (January 2010 - May 2020), 84 children with choledochal malformations (CM) (n = 84) were operated on with different surgical techniques in our hospitals. Group 1 - patients who had Roux-en-Y hepaticojejunoanastomosis (RYHJ, n = 68, 81%); Group 2 - patients who had hepaticoduodenoanastomosis (HD, n = 16, 19%). The authors compared outcomes because Roux-en-Y hepaticojejunostomosis and hepaticoduodenanastomosis were formed under mini-laparotomic (ML) and laparoscopic (LS) accesses. Surgical time, short-term and long-term postoperative outcomes were assessed.Results. The groups were comparable in gender, age, clinical manifestations, CM complications before surgery, comorbidities (p 0.05). A statistically significant (p = 0.0000001, Mann–Whitney U-test) decrease in the surgical time was revealed when using mini-laparotomy access. Independent defecation appeared 3 times faster in the subgroup with mini-laparotomy and Roux-en-Y hepaticojejunostomy (ML RYHJ) than in the subgroup of laparoscopic Roux-en-Y hepaticojejunostomy (LS RYHJ) (p = 0.033, Mann–Whitney U-test), mainly due to early enteral loading in the first subgroup (on 0-1 postoperative day). Long-term postoperative outcomes in laparoscopic subgroups revealed a statistically insignificant (p 0.05) prevalence of 4 anastomotic stenosis requiring repeated surgical interventions. Good outcomes were seen in 90% of patients after ML RYHJ (p = 0.002, Pearson’s Chi-square with Yates’ correction) versus 52.6% after LS RYHJ.Conclusion. Currently, laparoscopy is not a method of choice in children with CM due to the development of short-term and long-term postoperative complications. Minilaparotomy gives promising results in pediatric CM and can be “a gold standard” in the treatment of children with this pathology.