Roux -En-Y Hepaticojejunostomy versus Hepaticodudenostmy for Biliary Reconstruction after Excision of Choledochal Cysts in Children

Background/Purpose: Primary cyst excision combined with biliary reconstruction is the standard treatment of choledochal cysts. Roux-en-Y hepatico-jejunostomy (RYHJ) or hepatico-dudenostomy (HD) is the most commonly used techniques for biliary reconstruction. This study was undertaken to compare the operative details and postoperative functional results of patients treated with either RYHJ or HD on both early and long term follow up. Materials and Methods: This retrospective study included 27 patients with choledochal cysts, who were treated during the period from 1993 to 2005. Complete excision of the extra-hepatic cysts was done in all patients. The study population was classified into two groups according to the method used for biliary reconstruction. Group 1 included 18 patients who undergone RYHJ, while group 2 included 9 patients treated with HD. All patients were studied as regard to the details of clinical presentation, diagnostic tools, operative details, and outcome. Statistical comparison was done with unpaired t and x 2 tests, with P value less than 0.05 considered significant. Results: The age and sex distributions were comparable among both groups. The mean operative time was longer in group 1 than in group 2 (160.4 versus 131.1 minutes, P =0.003). Intraoperative blood transfusion was not required in any patient. The start of oral postoperative feeding was similar in both groups (2.6 versus 2.1 days). The hospital stay was comparable in both groups (5.1 versus 4.8 days). There were no major intraoperative complications in either group. Postoperative cholangitis occurred in 4 patients (2 in each group). Adhesive bowel obstruction occurred in 2 children in group I (treated successfully by conservative management). One late mortality due to liver failure occurred 6 months after RYHJ with preoperative severe liver cirrhosis. Conclusions: Total excision of choledochal cyst is usually feasible. Both RYHJ and HD are effective techniques for biliary reconstruction following excision of the cyst with satisfactory and comparable results on both early and long-term follow up. Hepatico-dudenostomy may be preferred due to shorter operative time and avoidance of intestinal anastomosis; however more patients with HD are required before reaching a solid conclusion.