title: Modified biliary-enteric anastomosis for congenital choledochal cyst: clinical and prognostic analysis of 91 cases.
abstract: OBJECTIVE
  To report our experience with a modified biliary-enteric anastomosis procedure for the surgical treatment of congenital choledochal cysts.
  
  
  METHODS
  Between January 2009 and December 2013, 91 children (19 boys, 72 girls; ages, 6-145 months) with congenital choledochal cysts were treated with our modified surgical procedure in our hospital. Of these patients, 69 had type I cysts, and 22 had type IV B cysts. The main parameters analyzed mainly included the operative time, duration of bowel recovery, resumption of diet, postoperative hospital stay, liver-function tests, postoperative complications, and prognosis.
  
  
  RESULTS
  The average operation duration was 129.34 ± 23.50 min. The time until first flatus and resumption of oral diet were 26.51 ± 4.13 h and 5.47 ± 0.77 day, respectively. The mean postoperative hospital stay was 11.84 ± 2.58 day. Postoperative complications occurred in six patients: intestinal obstruction (1 patient), postoperative bleeding (1 patient), postoperative pancreatitis (1 patient), and bile leakage (3 patients). During a follow-up of 2-7 years, four cases of occasional abdominal pain were found. Contrast agent reflux was detected on upper gastrointestinal imaging in three children. All children had good nutrition.
  
  
  CONCLUSIONS
  The modified biliary-enteric anastomosis is a safe, simple, and reliable technique. However, longer follow-up and a larger sample size are necessary to prove its efficacy in the treatment of congenital choledochal cysts.
authors.affiliation: Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
authors.forename: Ji
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yi
authors.affiliation: Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China. surgeonhuang@126.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China.
authors.forename: Xinmin
authors.initials: X
authors.lastname: Si
mesh_terms: D000714:Anastomosis, Surgical; D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000601:surgery*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
keywords: Choledochal cyst; Follow-up; Hepaticojejunostomy; Pediatrics