Comparative study of Hepatico-duodenostomy Vs. Hepatico-jejunostomy surgical procedures in the management of choledochal cyst in children

Background: Choledochal cyst is a congenital anomaly of the ducts of the extarhepaticbiliary tree. This condition is considered rare in the view of western population with an incidence of 1 in 100,000 to 150,000 births, while it defers in the Asian population where in the incidence is nearly 1 in 1000 live births. Aim: To compare and assess the advantages and disadvantages between the two standard procedures in the surgical management of choledochal cyst in children. Materials and methods: The required sample size was collected prospectively over a period of two years from November 2014 to October 2016. The decision for biliary-enteric anastomosis (Hepatico-duodenostomy Vs. Hepatico- jejunostomy) made was not influenced or directed by the study. The type of anastomosis was left to the surgeon's personal preference in each case.15 cases of each type of biliary-enteric anastomosis – Hepatico-duodenostomy and Hepatico-jejunostomy were chosen. Results: The age distribution in cases undergoing hepatico-duodenostomy was almost near to equal, female to male ratio was of 1.25: 1. Out of 15 patients 5 in hepatico-duodenostomy group and 3 in hepatico-jejunostomy had a palpable mass in the right upper quadrant. This means that a palpable mass was seen in 26% of our patients who present for surgical correction of a CC. Second most important presenting complaint in CC was pain. Thirteen out of 30 children presented with bilious vomiting. On an average, we had initiation of feeds in the hepatico-duodenostomy group was of 5 days and that of the hepatico-jejunostomy group was of 7 days. Average stay for the hepatico-duodenostomy group was around 7.6 days when compared to 10.5 days in the hepatico-jejunostomy group. One case in hepatico-jejunostomy group was seen to have bile leak on the 4 the post-operative day. No other early complications were seen in the hepatico-duodenostomy group. One child belonging to hepatio-duodenostomy group had been admitted three months post-operatively with the complaint of recurrent pain abdomen and fever. In cases of hepatico-duodenostomy, none of them presented with any symptoms of pain abdomen or recurrent vomiting. Conclusion: Our results also support HD as the preferred procedure for biliary reconstruction after resection of CC, in view of the advantages of relative simplicity, and low rate of complications.