Degtyareva A, et al. Pediatr Gastroenterol Hepatol Nutr. 2024 Jul;27(4):224-235. https://doi.org/10.5223/pghn.2024.27.4.224

Отдаленные результаты лечения детей с билиарной атрезией

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.

   Aim. To improve treatment outcomes for children with common bile duct cysts.   Materials and methods. The study enrolled children with common bile duct cysts (n = 84) examined from January 2010 to November 2023. All patients underwent cyst excision, Roux-en-Y hepaticojejunostomy laparoscopically or from a minilaparatomy access. A comparative analysis of the treatment outcomes was carried out to select the optimal access. The timing of surgery, as well as early and late postoperative complications were analyzed.   Results. The timing of surgery from the minilaparotomy access was shorter. Defecation in children of the minilaparotomy subgroup appeared 3 times earlier than in children after laparoscopic hepaticojejunostomy, largely due to earlier enteral load. A good treatment outcome was observed in 92 % of patients who underwent intervention from a minilaparotomy access compared to 52.2 % of patients who underwent laparoscopic surgery.   Conclusion. Currently, laparoscopic access is a non-optimal method for treatment of children with common bile duct cysts. Minilaparotomy appears to be a promising surgical access in children and may be proposed as a standard for common bile duct cysts.

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.

В настоящее время продолжается дискуссия относительно способа реконструкции желчных путей у детей с мальформацией общего желчного протока (МОЖП). ЦЕЛЬ ИССЛЕДОВАНИЯ Сравнительный анализ способов реконструкции желчных путей у детей с МОЖП. МАТЕРИАЛ И МЕТОДЫ За 10 лет мы наблюдали 99 детей с МОЖП. Для доступа к желчным путям (ЖП) использовали минилапаротомию (МЛ), лапароскопию (ЛС) и лапаротомию (ЛТ). Выполняли радикальную резекцию МОЖП и реконструкцию ЖП путем наложения гепатикоеюноанастомоза (ГЕ) по Ру и гепатикодуоденоанастомоза (ГД). Оценивали время операции, ранние и поздние послеоперационные осложнения. РЕЗУЛЬТАТЫ МЛ выполнена 39 пациентам, ЛС — 51, ЛТ — 9. При ЛС длительность пребывания детей в стационаре при сравнении экстракорпорального и интракорпорального формирования ГЕ статистически значимо меньше в случае интракорпорального ГЕ (p=0,02, U-критерий Манна—Уитни), тогда как время операции больше (p=0,0003). Самостоятельный стул в группе МЛ ГЕ появлялся в 3 раза быстрее, чем в группе ЛС ГЕ (p=0,016, U-критерий Манна—Уитни). Статистически значима меньшая длительность послеоперационного наркотического обезболивания в группе МЛ ГЕ: медиана в течение 3 сут после операции против 4 сут в группе ЛС ГД (p=0,02, U-критерий Манна—Уитни). МЛ ГЕ в нашем исследовании имеет преимущество над ЛС ГЕ при оценке поздних осложнений. При использовании ГД мы чаще встречали развитие тяжелого послеоперационного панкреатита (p=0,033), который требовал оперативной коррекции (ЛТ, p=0,043). ВЫВОДЫ МЛ с ГЕ в нашем исследовании обладает некоторыми преимуществами перед другими способами реконструкции ЖП. Поэтому можем рекомендовать этот метод как основной.