Minilaparotomy in the treatment of choledochal malformations in children



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Abstract

Introduction. The article presents the analysis of surgical treatment of children with choledochal malformations (CM) with mini-laparotomy and laparoscopy techniques.

Purpose. The aim of the study is to improve outcomes of surgical treatment of choledochal malformations in children.

Material and methods. For the last ten years (January 2010 - May 2020), 84 children with choledochal malformations (CM) (n = 84) were operated on with different surgical techniques in our hospitals. Group 1 - patients who had Roux-en-Y hepaticojejunoanastomosis (RYHJ, n = 68, 81%); Group 2 - patients who had hepaticoduodenoanastomosis (HD, n = 16, 19%). The authors compared outcomes because Roux-en-Y hepaticojejunostomosis and hepaticoduodenanastomosis were formed under mini-laparotomic (ML) and laparoscopic (LS) accesses. Surgical time, short-term and long-term postoperative outcomes were assessed.

Results. The groups were comparable in gender, age, clinical manifestations, CM complications before surgery, comorbidities (p > 0.05). A statistically significant (p = 0.0000001, Mann–Whitney U-test) decrease in the surgical time was revealed when using mini-laparotomy access. Independent defecation appeared 3 times faster in the subgroup with mini-laparotomy and Roux-en-Y hepaticojejunostomy (ML RYHJ) than in the subgroup of laparoscopic Roux-en-Y hepaticojejunostomy (LS RYHJ) (p = 0.033, Mann–Whitney U-test), mainly due to early enteral loading in the first subgroup (on 0-1 postoperative day). Long-term postoperative outcomes in laparoscopic subgroups revealed a statistically insignificant (p> 0.05) prevalence of 4 anastomotic stenosis requiring repeated surgical interventions. Good outcomes were seen in 90% of patients after ML RYHJ (p = 0.002, Pearson’s Chi-square with Yates’ correction) versus 52.6% after LS RYHJ.

Conclusion. Currently, laparoscopy is not a method of choice in children with CM due to the development of short-term and long-term postoperative complications. Minilaparotomy gives promising results in pediatric CM and can be “a gold standard” in the treatment of children with this pathology.

About the authors

A. Yu. Razumovskiy

Pirogov Russian National Research Medical University; After N.F. Filatov Children's City Clinical Hospital of the Department of Health of the City of Moscow

Email: fake@neicon.ru
ORCID iD: 0000-0002-9497-4070

Moscow, 117997; Moscow, 123001

Россия

Z. B. Mitupov

Pirogov Russian National Research Medical University; After N.F. Filatov Children's City Clinical Hospital of the Department of Health of the City of Moscow

Email: fake@neicon.ru
ORCID iD: 0000-0002-0016-6444

Moscow, 117997; Moscow, 123001

Россия

N. V. Kulikova

Pirogov Russian National Research Medical University; After N.F. Filatov Children's City Clinical Hospital of the Department of Health of the City of Moscow

Email: fake@neicon.ru
ORCID iD: 0000-0003-0834-2630

Moscow, 117997; Moscow, 123001

Россия

N. S. Stepanenko

Pirogov Russian National Research Medical University; After N.F. Filatov Children's City Clinical Hospital of the Department of Health of the City of Moscow

Email: fake@neicon.ru
ORCID iD: 0000-0002-2827-1764

Moscow, 117997; Moscow, 123001

Россия

A. S. Zadvernyuk

Pirogov Russian National Research Medical University; After N.F. Filatov Children's City Clinical Hospital of the Department of Health of the City of Moscow

Email: fake@neicon.ru
ORCID iD: 0000-0003-4379-8051

Moscow, 117997; Moscow, 123001

Россия

E. A. Titova

After N.F. Filatov Children's City Clinical Hospital of the Department of Health of the City of Moscow

Email: fake@neicon.ru
ORCID iD: 0000-0001-9901-6093

Moscow, 123001

Россия

N. V. Shubin

Pirogov Russian National Research Medical University; After N.F. Filatov Children's City Clinical Hospital of the Department of Health of the City of Moscow

Author for correspondence.
Email: koliashubin33@mail.ru
ORCID iD: 0000-0002-3838-0067

Nikolay V. Shubin, MD, post-graduate student at department of pediatric surgery in Pirogov Russian National Research Medical University

Moscow, 123001

Россия

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