Study of Operative Events and Time Requirement of Hepaticoduodenostomy for the Treatment of Type I Choledochal Cyst- the Experience at BSMMU Hospital.

Of all varieties, Type I Choledochal cyst causing saccular or fusiform dilatation of the extra-hepatic biliary ductal system is the commonest (90.0 - 95.0%). Its presentations vary. To restore the continuity of the extra-hepatic biliary tract after excision of type I Choledochal cyst, surgeons have few alternatives to use, with their advantages and disadvantages. Roux en-Y Hepatico-jejunostomy (RYHJ) has been very popular and long studied standard surgical treatment for type I Choledochal cyst. But now Hepatico-duodenostomy (HD) is also being practiced and studied in different centers all over the world for the treatment of the same disease. For the last five years, we, at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, have been using Hepatico-duodenostomy as preferred anastomotic option in treating type I Choledochal cyst. Here, we are presenting our experience at BSMMU Hospital, regarding operative events and time requirement of Hepaticoduodenostomy for the treatment of type I Choledochal cyst and, to show whether this procedure can be safely practiced, producing acceptable results. It is a retrospective document study, from January 2013 to December 2017, at BSMMU Hospital, on forty two, MRCP confirmed type I Choledochal cyst patients of pediatric age. Patients' particulars, history, physical examination, investigations (including MRCP confirmation), assessment, surgical plan were collected from relevant medical records and documented in duly coded individual data collection sheet maintaining standard privacy protocol. Information regarding presentations, operative findings and procedural events including per-operative mortality, injury to the vital structures during operation, conversion to RYHJ, operative time (minutes), blood loss and transfusion requirements (ml) of Heaticoduodenostomy for type I Choledochal cyst, were specially searched for. There was no operative mortality. None of these patients required per-operative blood transfusion. Nor there was any inadvertent injury to the adjacent structures. The mean operative time required for Hepaticoduodenostomy was 88 minutes with a range of 75 to 125 minutes. Through this study, at BSMMU Hospital, operative events and time requirement of Hepatico-duodenostomy for treating type I Choledochal cyst, was found to be yielding acceptable results, for safe practice.

Study of Immediate Postoperative Outcome of Hepaticoduodenostomy for the Treatment of Type I Choledochal Cyst: The Experience at BSMMU Hospital.

Excision of type I choledochal cyst mandates restoration of continuity of extrahepatic biliary drainage system through anastomotic options having their advantages and disadvantages. Roux en-Y Hepaticojejunostomy (RYHJ) has been very popular and long studied standard surgical treatment for type I choledochal cyst. But now Hepaticoduodenostomy (HD) is also being practiced and studied in different centers all over the world for the treatment of the same disease. We have been practicing Hepaticoduodenostomy for treating type I choledochal cyst, at Bangabandhu Sheik Mujib Medical University (BSMMU), for last five years. Here, we are presenting our experience at BSMMU Hospital, regarding immediate post-operative outcome of Hepaticoduodenostomy for the treatment of type I Choledochal cyst, to show whether this procedure can be safely practiced, producing acceptable results. It is a retrospective document review of forty two MRCP confirmed type I Choledochal cyst children, admitted and operated at BSMMU Hospital, from January 2013 to December 2017. Patient's particulars, history, physical examination, investigations (including MRCP confirmation), assessment, surgical plan were collected from relevant medical records under standard privacy protocol. Information regarding early post-operative outcome of Hepaticoduodenostomy in treating uncomplicated type I choledochal cyst were searched for review and evaluation, specifically with respect to- a) mortality (if any); b) morbidities like- i) prolonged post-operative abdominal pain, ii) anastomotic bile leak, iii) features of early Cholangitis, iv) wound dehiscence and c) prolonged Hospital stay. There was no immediate post-operative mortality. But 9(21.42%) patients had prolonged post-operative pain requiring parenteral Pethidine 'on demand' beyond second post-operative day, 2(4.76%) had anastomotic bile leak, 7(16.67%) had early cholangitis and 1(2.38%) had abdominal wound dehiscence; they (21.42%) also stayed in hospital for more than fourteen days. The outcome was acceptably safe when compared with other studies abroad. Through this study, at BSMMU Hospital, immediate post-operative outcome of Hepaticoduodenostomy for treating type I choledochal cyst- in terms of morbidity, mortality and hospital stay- was found to be yielding acceptable results, for safe practice.