The timing of surgery of antenatally diagnosed choledochal malformations: A descriptive analysis of a 26-year nationwide cohort.
BACKGROUND
Choledochal malformations (CMs) are increasingly diagnosed antenatally. There is a dilemma between early surgery to prevent CM-related symptoms and postponing surgery to reduce complications. We aimed to identify the optimal timing of surgery in asymptomatic neonates with antenatally diagnosed CM and to identify predictors for development of symptoms.


METHODS
Using the Netherlands Study group on CHoledochal Cyst/malformation (NeSCHoc) we retrospectively collected demographic, biochemical and surgical data from all Dutch patients with an antenatally detected CM.


RESULTS
Between 1989 and 2014, antenatally suspected CM was confirmed in 17 patients at a median age of 10days (1day-2months). Four patients developed symptoms directly after birth (24%). Thirteen patients (76%) remained asymptomatic. Two of these progressed to symptoms before surgical intervention at 0.7 and 2.1months resp. Postoperatively, four patients developed short-term complications and three developed long-term complications. Patients <5.6kg (the series median) showed more short-term complications (66%) when compared to patients >5.6kg (0%, p=0.02).


CONCLUSIONS
When not symptomatic within the first days of life, the majority of children with antenatally detected CM remains asymptomatic. Surgery might safely be delayed to the age of 6months or a weight of 6kg. Postponing surgery in the clinically and biochemical asymptomatic patient might decrease the complication rate.


METHODS
Level III.
Department of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Maria H A
MHA
van den Eijnden
Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Ruben H
RH
de Kleine
Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands.
Ivo
I
de Blaauw
Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Paul M J G
PMJG
Peeters
Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Bart G P
BGP
Koot
Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Matthijs W N
MWN
Oomen
Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
Cornelius E J
CEJ
Sloots
Department of Pediatric Surgery, University Medical Center Maastricht, Maastricht, The Netherlands.
Wim G
WG
van Gemert
Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
David C
DC
van der Zee
Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
L W Ernest
LWE
van Heurn
Department of Pediatrics, University of Groningen, University Medical Center Groningen, University of Groningen, The Netherlands.
Henkjan J
HJ
Verkade
University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland.
Jim C H
JCH
Wilde
Department of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.b.f.hulscher@umcg.nl.
Jan B F
JBF
Hulscher
D000328:Adult; D002648:Child; D015529:Choledochal Cyst / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
Antenatal diagnosis; Choledochal cysts; Choledochal malformation