Biliary duodenostomy: a safe and easier biliary drainage procedure after choledochal cyst excision

Abstract

Background/purpose: The treatment of choice for choledochal cyst (CC) is complete excision followed by biliary–enteric anastomosis. Roux-en-Y biliary jejunostomy has been favored by most surgeons for decades, with satisfying results. The use of biliary duodenostomy (BD) is another simple alternative for biliary drainage after CC excision. Our intermediate-term outcomes of both biliary drainage procedures after CC excision are presented.

Methods: We carried out a retrospective analysis of the outcome of CC management in children operated at the Pediatric Surgery Department of Ain-Shams University over 5 years, from January 2010.

Results: A total of 23 cases (16 females) were included in this study. The mean age at operation was 4.02 ± 2.52 years. Twenty-one cases had type I and two cases had type III CC. Complete excision of the CC was performed in 22 cases, and partial excision with mucosectomy was performed in one case. Biliary–enteric anastomosis was performed with the duodenum in 18 patients (group I, BD) and with the jejunum in five cases (group II, Roux-en-Y biliary jejunostomy). The mean follow-up period was 53± 4.48 months. A patient from group II suffered from ascending cholangitis 6 months postoperatively.

Conclusion: BD is a simple technique for biliary drainage after CC excision with no major complications at intermediate-term follow-up.

Keywords: biliary obstruction, choledochal cyst, hepaticoduodenostomy, jaundice