A B Alkhasov, A S Gurskaya, R R Bayazitov, O N Nakovkin, M A Sulavko, I V Karnuta, E V Ekimovskaya, I A Kyarimov, D M Akhmedova, A A Klepikova, S A Ratnikov, A P Fisenko
{"title":"[Choledochal cysts: surgical treatment in newborns and infants].","authors":"A B Alkhasov, A S Gurskaya, R R Bayazitov, O N Nakovkin, M A Sulavko, I V Karnuta, E V Ekimovskaya, I A Kyarimov, D M Akhmedova, A A Klepikova, S A Ratnikov, A P Fisenko","doi":"10.17116/hirurgia20240315","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To improve postoperative outcomes in newborns and infants with choledochal cysts and to determine the indications for surgery.</p><p><strong>Material and methods: </strong>There were 13 children aged 0-3 months with choledochal cyst who underwent reconstructive surgery between 2019 and 2023. In all children, choledochal cyst was associated with cholestasis. Acholic stool was observed in almost half of the group (<i>n</i>=7). All children underwent cyst resection and Roux-en-Y hepaticoenterostomy.</p><p><strong>Results: </strong>Symptoms of cholestasis regressed in all patients. Mean surgery time was 128±27 min. There were no complications. Enteral feeding was started after 1-2 postoperative days, abdominal drainage was removed after 6.2±1.6 days. Mean length of hospital-stay was 16±3.7 days. Adequate bile outflow is one of the main principles. For this purpose, anastomosis with intact tissues of hepatic duct should be as wide as possible. Roux-en-Y loop should be at least 40-60 cm to prevent postoperative cholangitis.</p><p><strong>Conclusion: </strong>Drug-resistant cholestasis syndrome and complicated choledochal cysts (cyst rupture, bile peritonitis) are indications for surgical treatment in newborns and infants. When forming Roux-en-Y hepaticoenterostomy, surgeon should totally excise abnormal tissues of the biliary tract to prevent delayed malignant transformation.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"5-13"},"PeriodicalIF":0.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Khirurgiya","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.17116/hirurgia20240315","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To improve postoperative outcomes in newborns and infants with choledochal cysts and to determine the indications for surgery.
Material and methods: There were 13 children aged 0-3 months with choledochal cyst who underwent reconstructive surgery between 2019 and 2023. In all children, choledochal cyst was associated with cholestasis. Acholic stool was observed in almost half of the group (n=7). All children underwent cyst resection and Roux-en-Y hepaticoenterostomy.
Results: Symptoms of cholestasis regressed in all patients. Mean surgery time was 128±27 min. There were no complications. Enteral feeding was started after 1-2 postoperative days, abdominal drainage was removed after 6.2±1.6 days. Mean length of hospital-stay was 16±3.7 days. Adequate bile outflow is one of the main principles. For this purpose, anastomosis with intact tissues of hepatic duct should be as wide as possible. Roux-en-Y loop should be at least 40-60 cm to prevent postoperative cholangitis.
Conclusion: Drug-resistant cholestasis syndrome and complicated choledochal cysts (cyst rupture, bile peritonitis) are indications for surgical treatment in newborns and infants. When forming Roux-en-Y hepaticoenterostomy, surgeon should totally excise abnormal tissues of the biliary tract to prevent delayed malignant transformation.
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