Original Articles

Outcomes of Hepaticoduodenostomy over T-tube against Roux-en-Y Hepaticojejunostomy to Restore Bilio-enteric Continuity after Choledochal Cyst Excision in Children

Thakur VK, Yadav RD, Chaubey D, Keshri R, Hasan Z, Kumar V, Prasad R, Kumar R, sandip kumar rahul

Iranian Journal of Pediatric Surgery, Vol. 7 No. 2 (2021), 12 June 2021 , Page 68-79

Introduction: Any surgical procedure which would restore the bilio-enteric continuity after excision of the choledochal cyst with minimal complications would be a feasible alternative to Hepaticojejunostomy using a Roux loop of jejunum. To determine the outcomes of Hepaticoduodenostomy done over T-Tube against Roux-en-Y Hepaticojejunostomy for bilio-enteric reconstruction after excision of choledochal cyst.

Materials and Methods: This study was retrospectively done on all patients of choledochal cysts (Types 1 and 4) operated between January, 2014 and December, 2019. The clinical details, intra-operative and post-operative results of patients who underwent Roux-en-Y Hepatico-Jejunostomy (Group-1) and Hepatico-duodenostomy over T-Tube (Group -2) for establishing bilio-enteric continuity after excision of choledochal cyst were compared and analyzed statistically.

Results: 78 patients of choledochal cysts were operated during this period with 31 patients in Group-1 and 47 in Group-2; there was no difference in the mean age or size of the cysts in the two groups; Type 1 cysts were the most common with female preponderance in both groups. Group-2 patients had lesser intra-operative time andfewer numbers of sutures were used during surgery. There was no difference in the incidence of anastomotic leaks, strictures, cholangitis or adhesive obstruction and reoperation rates between the two groups. Group 2 showed increased nasogastric bilious aspirates in 19.15% of cases which improved on conservative management.

Conclusion: Bilio-enteric reconstruction using Hepaticoduodenostomy over T-Tube is a simpler, lower pressure and less time taking anastomotic technique with comparable complication rates when compared to Roux-en-Y Hepaticojejunostomy in the management of choledochal cysts.

Comparison Outcomes of Divided End Loop Versus Separate Double Barrel Colostomy in Neonates with Imperforate Anus

Shahnam Askarpur, Mehran Peyvasteh, Khalil Kazemnia, Hazhir Javaherzadeh

Iranian Journal of Pediatric Surgery, Vol. 7 No. 2 (2021), 12 June 2021 , Page 80-87

Introduction: the aim of current is to compare clinical outcomes between the divided end loop and separate double barrel colostomy in neonates with imperforate anus.

Materials and Methods: This is a retrospective study to review 184 patients who presented with imperforate anus and were managed with a divided end loop or separate double barrel colostomy between 2017 and 2020. Complications were compared in the two groups.

Results: There was more skin excoriation in separate double barrel colostomy compared to divided end loop colostomy (p=0.001).  The mean of scar size in patients of divided end loop colostomy group was lower than that of separate double barrel colostomy significantly (p<0.0001).

Conclusion: Our results suggest that divided end loop colostomy may be more acceptable than separate double barrel colostomy for neonates with imperforate anus.