title: Coagulopathy in a subtype of choledochal cyst and management strategy.
abstract: OBJECTIVE
  To evaluated our management algorithm of the coagulopathy. We evaluated our management algorithm of the coagulopathy.
  
  
  METHODS
  Between October 2001 and January 2013, 160 CDC children with coagulopathy (fibrinogen, FIB < 2 g/L) were recruited. FIB ≥ 1 g/L is generally required for safe elective surgery. We used FIB level as an indicator when: (1) patients with FIB levels between 1-2 g/L underwent one-stage definitive operation; and (2) patients with FIB < 1 g/L underwent 3 d of medical treatment. Thereafter, those with FIB ≥ 1 g/L underwent one-stage definitive operation whereas those with FIB < 1 g/L underwent external biliary drainage to allow liver function improvement. Those patients with liver function improvements underwent definitive operation after 7 d of drainage.
  
  
  RESULTS
  After preoperative optimization, 92.5% of CDC children with coagulopathy underwent successful one-stage definitive operation. The remaining 7.5% of CDC children required initial external bile drainage, and underwent definitive operation 11 d after the admission. The mean operative time and postoperative recovery duration were comparable to those with normal coagulations. The median follow-up period was 57 mo. No blood transfusion or other postoperative complications were encountered.
  
  
  CONCLUSIONS
  Following our management protocol, the majority of CDC children with coagulopathy can be managed with one-stage definitive operation.
authors.affiliation: Mei Diao, Long Li, Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Diao
authors.affiliation: Mei Diao, Long Li, Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, China.
authors.forename: Long
authors.initials: L
authors.lastname: Li
authors.affiliation: Mei Diao, Long Li, Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002648:Child; D015529:Choledochal Cyst / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D019091:Critical Pathways; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D004322:Drainage / Q000009:adverse effects; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D010535:Laparoscopy; D008111:Liver Function Tests; D008297:Male; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005340:Fibrinogen
keywords: Children; Choledochal cysts; Coagulopathy; Hepatic dysfunction; Hepaticojejunostomy; Laparoscopy