Early complications after excision with hepaticoenterostomy for infants and children with choledochal cysts

Objective: To retrospectively study the early compli-cations of excision with hepaticoenterostomy for in-fants and children with choledochal cysts.Methods: We analyzed 16 patients with early posto-perative complications out of 173 patients with con-genital choledochal cysts aged 27 days to 14 years(mean 2.4 years) who had undergone excisional pro-cedures and biliary tract reconstruction.Results: The early complications included bile leak-age (10 patients), abdominal wall dehiscence (3),and hepatic failure, pancreatic juice leakage andpostoperative intussusception (each in 1) respective-ly. Three patients died from bile leakage and 1 frompostoperative hepatic failure. No statistical differen-ces were observed between the procedures of biliarytract reconstruction with jejunal segment interposi-tion hepaticoduodenostomy and Roux-en-Y hepatico-jejunostomy (P>0.75). The morbidity was signifi-cantly higher in infants below 1 year than in children(P<0.005). Prevention and treatment of the com-plications were discussed.Conclusion: Bile leakage and abdominal wall dehis-cence are major early postoperative complications.The morbidity of cholechal cysts is higher in infantsthan in children. Exploratory laparotomy should notbe delayed when biliary leakage with diffuse peritoni-tis appears. The "tension suture in the fascial spaceof the abdominal wall" is useful to prevent and treatwound dehiscence.