Growth in children with choledochal malformations: effect of the Roux loop.
OBJECTIVE
Excision and biliary reconstruction using a Roux loop is the current standard for choledochal malformation (CM). This is un-physiological, delivering bile beyond the duodenum and excluding a significant length of the jejunum from intestinal absorption. We investigated whether this had an effect on post-operative growth.


METHODS
Retrospective case-note analysis of children surgically treated for CM. Growth variables were converted to standard deviation scores (SDS) and compared against population norms. P < 0.05 was significant.


RESULTS
From 1994 to 2014, 135 children (<16 years) were identified. Median age at surgery was 3.3 (IQR 1.5-7) years. Morphology included: type 1 Cystic (n = 54, 40%), type 1 Fusiform (n = 58, 43%) and type 4 (intra and extra-hepatic) (n = 22, 16%). There was pre-operative growth failure [median weight SDS = -0.4 (-1.2 - 0.4), P = 0.0004] with a similar trend for height [SDS = -0.38 (-1.2 - 0.5), P = 0.08)]. This correlated with presentation bilirubin (r s = -0.24, P = 0.004), GGT (r s = -0.27, P = 0.002) and AST (r s = -0.27, P = 0.002) but not morphology (P = 0.82) or presentation (P = 0.4). Median follow-up was 1.9 (0.6-4.7) years, during which time both height (P = 0.73) and weight (P = 0.45) reverted to normal.


CONCLUSIONS
This is the first report of growth in children with CM following a Roux-loop reconstruction and showed pre-operative growth failure probably attributed to a period of biliary obstruction but catch-up growth when corrected.
Department of Paediatric Surgery, King's College Hospital, London, SE5 9RS, UK.
Kathryn E
KE
Ford
Department of General Surgery, Royal Free Hospital, London, UK.
Lilli R L
LR
Cooper
Department of Paediatric Surgery, King's College Hospital, London, SE5 9RS, UK. markdav2@ntlworld.com.
Mark
M
Davenport
D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery*; D001827:Body Height / Q000502:physiology*; D001835:Body Weight / Q000502:physiology*; D002648:Child; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
Choledochal malformation; Growth failure; Hepaticojejunostomy; Roux-en-Y loop