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01-12-2023 | Original Article

Oncologic safety of Carrel patch hepaticojejunostomy for treating cystic-type choledochal cyst in children based on 20-plus years follow-up

Authors: Junya Ishii, Go Miyano, Toshiaki Takahashi, Takanori Ochi, Yuichiro Miyake, Hiroyuki Koga, Shogo Seo, Geoffrey J. Lane, Koji Fukumoto, Atsushi Arakawa, Atsuyuki Yamataka

Published in: Pediatric Surgery International | Issue 1/2023

Abstract

Aim

During choledochal cyst (CC) excision, the hepaticojejunostomy anastomosis (HJA) can be performed conventionally (CHJA) or with a Carrel patch (CPA). CPA can increase CHD diameter to 10–13 mm, preventing anastomotic stenosis and intrahepatic bile duct (IHBD) stones but may be at risk for malignant transformation.

Methods

The medical records of 83 cystic-type CC with CHD ≤ 9 mm followed up for at least 20 years were reviewed retrospectively. Available excised CC specimens (70/83) were re-examined blindly for pre-malignant changes. A questionnaire about suturing narrow lumens was conducted.

Results

All 83 had pancreaticobiliary maljunction. Group data were similar. Anastomoses were CPA (n = 43) and CHJA (n = 40). Mean diameter for CPA was 11.4 mm (range: 10–13 mm); for CHJA was 7.4 mm (range: 5–9 mm). Mean follow-up was 27.7 years (range: 20–42). Postoperative anastomotic stenoses were less after CPA: 1/43 (2.3%) versus 5/40 (12.5%) (p = 0.10), but CHJA had significantly more postoperative IHBD stones: 0% versus 4/40 (10.0%) (p < 0.05). All IHBD stone patients had anastomotic stenosis. Excised specimens showed no pre-malignant cytology. Lumen diameter ≤ 9 mm was considered challenging by 10/10 surgical trainees and ≤ 7 mm by 16/22 pediatric surgeons.

Conclusions

CPA appears to be oncologically safe because of the absence of malignant transformation for at least 20 years.

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Title: Oncologic safety of Carrel patch hepaticojejunostomy for treating cystic-type choledochal cyst in children based on 20-plus years follow-up
Authors: Junya Ishii
Go Miyano
Toshiaki Takahashi
Takanori Ochi
Yuichiro Miyake
Hiroyuki Koga
Shogo Seo
Geoffrey J. Lane
Koji Fukumoto
Atsushi Arakawa
Atsuyuki Yamataka
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 1/2023
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-022-05339-0

At a glance: The STEP trials

Springer Medicine

Oncologic safety of Carrel patch hepaticojejunostomy for treating cystic-type choledochal cyst in children based on 20-plus years follow-up

Abstract

Aim

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Aim

Methods

Results

Conclusions

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