Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy after excision of choledochal cyst: A randomized clinical trial and experience in a tertiary care hospital

Abstract

Introduction: Excision of choledochal cyst is required to relieve biliary obstruction thereby protecting the liver and pancreas as well as to prevent malignancy in long term. But controversy persists in the two existing techniques of biliary reconstruction after cyst excision. Aim: To analyze the clinical presentation, incidence and types of choledochal cyst and our experience in management of these congenital anomalies. To compare the advantages and disadvantages between two modalities of biliary reconstruction. Methods: A prospective, controlled, clinical trial was conducted on patients with choledochal cyst in a tertiary care pediatric surgery hospital. They were divided into two groups; Group–A: Patients in whom biliary reconstruction was done by Roux-en-Y hepaticojejunostomy, Group-B: Biliary reconstruction done by Hepaticoduodenostomy. The two groups were compared in respect to clinical course, types of cyst, surgical difficulties with special emphasis on operating time, postoperative complications. Results: Choledochal cysts accounted for 0.79% of total admissions at our institute. Out of 31 admitted cases, 22 cases were enrolled in the study. The number of patients in group A were 10 and in group B were 12. Abdominal pain was the commonest presenting feature and Type I choledochal cyst was the most common finding. The average duration of surgery was less in group B (1 hour 25 min) than in group A (2 hours and 10 min). Conclusion: Biliary reconstruction by Hepaticoduodenostomy takes significantly less operative time than Roux-en-Y hepaticojejunostomy (P<0.05) and needs single anastomosis. It is more anatomical, physiological, easy to perform and associated with fewer complications.