title: Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: a systematic review and meta-analysis.
abstract: BACKGROUND
  Excision has been established as a standard management practice for choledochal cysts in the last few decades. The two most commonly performed methods of reconstruction after excision are hepaticoduodenostomy (HD) and Roux-en-Y hepaticojejunostomy (HJ), of which the HJ is favored by most surgeons. Evidence concerning the optimal method of reconstruction is, however, sparse.
  
  
  METHODS
  Studies comparing outcomes from HD and HJ after choledochal cyst excision were identified by searching Medline, Ovid, Search Medica, Elsevier Clinicalkey, Google Scholar and Cochrane library. Suitable studies were chosen and data extracted for meta-analysis. Outcomes evaluated included operative time, hospital stay and incidence of postoperative bile leak, cholangitis, reflux/gastritis, anastomotic stricture, bleeding, intestinal obstruction and re-operative rate. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables.
  
  
  RESULTS
  Six retrospective studies were included in this meta-analysis, comprising a total of 679 patients, 412 of whom (60.7%) underwent HD, and the remainder, 267 (39.3%) underwent HJ. Although, HD group had slightly shorter hospital stay (MD: 0.30; 95% CI: -0.22-0.39; P < 0.00001) it showed a higher incidence of postoperative reflux/gastritis (OR: 0.08; 95% CI: -0.02-0.39; P = 0.002). However, the other outcomes such as bile leak, cholangitis, anastomotic stricture, bleeding, operative time, reoperation rate and adhesive intestinal obstruction did not differ between HD and HJ groups.
  
  
  CONCLUSIONS
  HD shows higher postoperative reflux/gastritis than HJ but a shorter hospital stay. There are few good-quality studies that compare the outcomes from HD and HJ, meaning that caution should be exercised in the generalization of the results of this meta-analysis, which suggests HD to be comparable with HJ in terms of other complications, operative benefits and outcomes.
authors.affiliation: Department of Pediatric Surgery, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia. Electronic address: drsharat77@gmail.com.
authors.forename: Sarath Kumar
authors.initials: SK
authors.lastname: Narayanan
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.forename: Kannan Laksmi
authors.initials: KL
authors.lastname: Narasimhan
authors.forename: Ralph Clinton
authors.initials: RC
authors.lastname: Cohen
mesh_terms: D000713:Anastomosis, Roux-en-Y; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology; D001646:Bile; D002761:Cholangitis / Q000453:epidemiology / Q000209:etiology; D015529:Choledochal Cyst / Q000601:surgery*; D003251:Constriction, Pathologic; D004385:Duodenostomy / Q000379:methods* / Q000706:statistics & numerical data; D005756:Gastritis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology; D007582:Jejunostomy / Q000379:methods* / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Choledochal cyst; Hepaticoduodenostomy; Hepaticojejunostomy; Meta-analysis