Early complications after cyst excision with
hepaticoenterostomy for choledochal cysts in infants and children
Li M-J, Feng J-X, Jin Q-F
Children’s Hospital, Zhejiang
University, Hangzhou, China
Objective: Retrospective study of
early complications of cyst excision with hepaticoenterostomy for
choledochal cysts in infants and children.
Methods: 16 cases of early
postoperative complications among the 173 cases of congenital choledochal
cysts aged 27 days to 14 years (mean age 2.4 years) who underwent excisional
procedure and biliary tract reconstruction were reviewed. The prevention
and treatment of the complications were discussed.
Results: 16 cases of early
postoperative complications included bile leakage in 10 cases, wound
dehiscence in 3 cases, hepatic failure, pancreatic juice leakage and
postoperative intussusception each in 1 case respectively. The incidence of
complications was 9.3% (16/173). 3 cases died from bile leakage and 1 case
died from postoperative hepatic failure. The mortality of total group was
2.3% (4/173). No statistic differences of complications between the
procedures of biliary tract reconstruction with jejunal segment
interposition hepaticoduodenostomy and Roux-en-Y hepaticojejunostomy (P>0.75). The morbidity in infancy
younger than 1 year was significantly higher than in children（P<0.005）.
Conclusion: The postoperative complications are more frequent in infants
than in children. Bile leakage and abdominal wall dehiscence were the main
early postoperative complications in infants. Candida albicans cholangitis
is rare complication after biliary leakage and extremely difficult to
treatment. It could penetrate the hepatic artery causing intermittent
biliary bleeding. Wound dehiscence is also a common complication after cyst
excision, especially in infants. The “tension suture in fascial space of
abdominal wall” could be employed to prevention and close the wound
dehiscence.