Abstract
Background: The optimal bile leakage management strategy in the pediatric population following the initial Roux-en-Y hepaticojejunostomy is still a matter of discussion today. Here, we assessed the roles of bile leakage management and surgical implementation on outcomes for patients with bile leakage.Materials and Methods: A revised protocol for bile leakage management with restricted surgical intervention was implemented at Chongqing Children’s Hospital on March 15, 2013 and Sanxia Hospital on April 20, 2013. We performed a retrospective, historical control analysis for the protocol implementation to compare the short- and long-term outcomes using the corresponding statistical methods.Results: There was a total of 84 patients included in the analysis, including 46 patients in the pre-protocol group and 38 patients in the post-protocol group. No statistical differences for the demographic features were found between the two groups. There was a decrease in redo surgeries in the post-protocol cohort compared to those in the pre-protocol cohort (odds ratio [OR] = 4.48 [95% CI, 1.57–12.77]; p = 0.003). Furthermore, patients in the post-protocol group were less likely to be associated with intensive care unit (ICU) admission (OR = 3.72 [95% CI, 1.11–12.49]; p = 0.024) compared to patients in the pre-protocol group, respectively. There was no mortality between the two groups.Conclusions: A restrictive surgical intervention strategy can effectively reduce the rate of redo surgery and exhibited promising outcomes for bile leakage in terms of postoperative recovery and hospitalization costs.
Highlights
The preferred management for choledochal cysts is cyst excision with biliary reconstruction for hepaticojejunostomy
Despite improvements in operative skill and perioperative care, shortand long-term complications still remain common in children, among them, bile leakage is a major source of concern [1,2,3]
Since 2012, bile leakage was defined biochemically by a bilirubin ratio of the drain fluid to serum of at least 3.0 on or after postoperative day 3 based on the criteria of the International Study Group of Liver Surgery (ISGLS) [9]
Summary
The preferred management for choledochal cysts is cyst excision with biliary reconstruction for hepaticojejunostomy. The management of bile leakage usually varied by the individual surgeon or institutional philosophy from conservation management to a multidisciplinary approach, such as, endoscopic dilatation, percutaneous drainage, etc., Leakage with severe clinical manifestations or failure of the multidisciplinary approach generally needs redo surgery [8]. It is a matter of debate on the timing of the surgical intervention and not enough high-quality evidence to either encourage or discourage the surgical treatment of this troublesome problem, and so the optimal strategy for bile leakage is still debated [9,10,11,12]. We assessed the roles of bile leakage management and surgical implementation on outcomes for patients with bile leakage
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