Modified biliary-enteric loop type anastomosis for congenital choledochal cyst: a retrospective study of 91 cases

Abstract

Objective To evaluate the efficacies of modified biliary-enteric loop type (Warren's) anastomosis of congenital choledochal cyst (CC) in children. Methods From January 2009 to December 2013, a total of 91 CC children were enrolled. Their clinical manifestations included abdominal pain, jaundice and white stool, etc. There were 19 males and 72 females with an age range of 6-145 months. The Todani types of CC were typeⅠ(n=69) and typeⅣ (n=22) according to the diagnostic criteria of ultrasound type B, abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography. Results The average operative duration was (129.34±23.50) mins. The initial flatus time was (26.51±4.13) hours and the time to resume eating was (5.47±0.77) days. The average length of postoperative hospital stay was (11.84±2.58) days. Postoperative complications included intestinal obstruction (n=1), postoperative pancreatitis (n=1) and bile leakage (n=3). One case of intestinal obstruction necessitated re-exploration. And 4 cases of bile leakage or postoperative pancreatitis were cured by conservative measures. During a follow-up period of 7-60 months, 4 cases of occasional abdominal pain had no underlying organic illness. Three asymptomatic cases had contrast agent refluxing on upper gastrointestinal imaging. According to nutritional assessments, all children were of good nutrition. Conclusions Modified biliary-enteric loop type anastomosis is safe, simple and reliable for CC. However, a long follow-up period with a large sample size is necessary for confirming its long-term efficacies. Key words: Choledochal cyst; Anastomosis, surgical; Follow-up studies