Late postoperative complications of congenital biliary dilatation in pediatric patients: a single-center experience of managing complications for over 20 years

• Published in: Surgery today (Tokyo, Japan) Vol. 51; no. 9; pp. 1488 - 1495
• Main Authors: Amano, Hizuru, Shirota, Chiyoe, Tainaka, Takahisa, Sumida, Wataru, Yokota, Kazuki, Makita, Satoshi, Takimoto, Aitaro, Tanaka, Yujiro, Hinoki, Akinari, Kawashima, Hiroki, Uchida, Hiroo
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01-09-2021
• Subjects: Age Factors; Anastomosis, Surgical - methods; Bile Ducts, Extrahepatic - surgery; Biliary Tract Surgical Procedures - methods; Cholangiopancreatography, Endoscopic Retrograde - methods; Cholangitis - epidemiology; Cholangitis - therapy; Choledochal Cyst - surgery; Cholestasis - epidemiology; Cholestasis - therapy; Female; Follow-Up Studies; Humans; Intestinal Obstruction - epidemiology; Intestinal Obstruction - therapy; Male; Medicine; Medicine & Public Health; Original Article; Postoperative Complications - epidemiology; Postoperative Complications - therapy; Retrospective Studies; Surgery; Surgical Oncology; Time Factors; Congenital biliary dilatation; Bile duct stenosis; Double-balloon endoscopic retrograde cholangiography; Late postoperative complication; Pediatric
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-021-02238-0

Purpose
To investigate late complications after surgery for congenital biliary dilatation (CBD).
Methods
We retrospectively reviewed the patients treated for late postoperative complications of extrahepatic bile duct resection with bilioenteric anastomosis for CBD at our hospital between 1999 and 2019.
Results
Twenty-seven complications, including bile duct stenosis with (
n
 = 19) or without (
n
 = 3) hepatolithiasis, remnant intrapancreatic bile duct (
n
 = 2), intestinal obstruction (
n
 = 2), and refractory cholangitis (
n
 = 1) were treated in 26 patients. The median age at radical surgery and the initial treatment of complications was 3 years, 2 months and 14 years, 5 months, respectively. The median period from radical surgery to initial treatment of complications was 7 years, 1 month. Before 2013, bile duct stenosis was initially treated with bile duct plasty (
n
 = 11) or hepatectomy (
n
 = 3), and 71.4% (
n
 = 10) of patients needed further treatment; after 2013, double-balloon endoscopic retrograde cholangiography (DBERC) was used (
n
 = 8), and 25% (
n
 = 2) of patients needed further treatment. Patients with remnant intrapancreatic bile duct, intestinal obstruction, and refractory cholangitis required surgery.
Conclusion
Long-term follow-up is necessary after surgery for congenital biliary dilatation. DBERC is thus considered to be useful for bile duct stenosis management.