Bile duct reconstruction in choledochal malformations in children

Introduction. Currently, there is ongoing discussion regarding the method of biliary tract reconstruction in children with choledochal malformations (CM).

Purpose. To make a comparative analysis of the techniques applied in bile duct reconstruction in children with CM.

Material and methods. For 10 years we have admitted 99 patients with CM. 84 children with CM were operated on from January 2010 to May 2020. Group 1 - patients who had Roux-en-Y hepaticojejunostomy (RYHJ, n = 68, 81%); Group 2 - patients who had hepaticoduodenostomy (HD, n = 16, 19%). The surgical access varied depending on the biliodigestive anastomosis technique. It was mini-laparotomy and laparoscopy. Surgical time, short-term and long-term postoperative outcomes were analyzed.

Results. Groups were comparable in gender, age, clinical manifestations, CM complications before surgery, accompanied comorbidity (p > 0.05). It was found that CM types differ depending on the child’s age when the diagnosis was established ( p = 0.0493, Kruskal- Wallis test); there was also a statistically significant difference in the pair between CM 1C and CM 1F (p = 0.0164, paired post-test). It means that children with CM 1F were older, median age 49 months (Q1-Q3: 12-86 months), than children with CM 1C, median age 14 months (Q1-Q3: 5-30 months). In HD group, severe postoperative pancreatitis, which was not controlled with conservative therapy, developed more often (n = 2) (p <0.05) and required a number of repeated surgeries including re-hepatico and hepaticojejunostomoses, thus prolonging the length of stay in ICU and increasing much the number of bed days.

Conclusion. In our study, RYHJ technique has some advantages over HD one. Therefore, at present we can recommend it as a basic one.