Hepaticoduodenostomy vs hepaticojejunostomy for reconstruction after resection of choledochal cyst.
OBJECTIVE
Roux-en-Y hepaticojejunostomy (HJ) is currently the favored reconstructive procedure after resection of choledochal cysts. Hepaticoduodenostomy (HD) has been argued to be more physiologically and technically easier but is feared to have associated complications. Here we compare outcomes of the 2 procedures.


METHODS
A retrospective chart review identified 59 patients who underwent choledochal cyst resection within our institution from 1999 to 2009. Demographic and outcome data were compared using t tests, Mann-Whitney U tests, and Pearson χ(2) tests.


RESULTS
Fifty-nine patients underwent repair of choledochal cyst. Biliary continuity was restored by HD in 39 (66%) and by HJ in 20 (34%). Open HD patients required less total operative time than HJ patients (3.9 vs 5.1 hours, P = .013), tolerated a diet faster (4.8 days compared with 6.1 days, P = .08), and had a shorter hospital stay (7.05 days for HD vs 9.05 days for HJ, P = .12). Complications were more common in HJ (HD = 7.6%, HJ = 20%, P = .21). Three patients required reoperation after HJ, but only one patient required reoperation after HD for a stricture (HD = 2.5%, HJ = 20%, P = .037).


CONCLUSIONS
In this series, HD required less operative time, allowed faster recovery of bowel function, and produced fewer complications requiring reoperation.
The Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Matthew T
MT
Santore
Brittany J
BJ
Behar
Thane A
TA
Blinman
Edward J
EJ
Doolin
Holly L
HL
Hedrick
Peter
P
Mattei
Michael L
ML
Nance
N Scott
NS
Adzick
Alan W
AW
Flake
D000713:Anastomosis, Roux-en-Y / Q000379:methods; D000714:Anastomosis, Surgical; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000601:surgery*; D004385:Duodenostomy / Q000379:methods; D005260:Female; D005704:Gallbladder; D006801:Humans; D007223:Infant; D007422:Intestines; D007582:Jejunostomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D008099:Liver; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D016896:Treatment Outcome