Comparison of Hepaticoduodenostomy with Hepaticojejunostomy in the Laparoscopic Management of Choledochal Cyst in Children: A Systematic Review and Meta-Analysis.

[BACKGROUND] There has been systematic review and meta analysis (SRMA) on comparison of hepaticoduodenostomy (HD) and hepaticojejunostomy (HJ) in choledochal cysts (CDC), which included both open and laparoscopic procedures. There is no SRMA, comparing them in pediatric CDC which were managed exclusively by laparoscopy.

[METHODS] Studies comparing laparoscopic HD and HJ after CDC excision were identified from Medline, Ovid, Google Scholar, and Cochrane library. Suitable studies were reviewed and meta-analyzed. Outcomes evaluated included operative time, hospital stay, and incidence of postoperative bile leak, cholangitis, reflux/gastritis, anastomotic stricture, bleeding, intestinal obstruction, and re-operative rate.

[RESULTS] Nine retrospective studies were included, comprising total of 1903 patients, 457 of whom (24%) underwent HD, and 1446 (76%) underwent HJ. There was higher incidence of cholangitis in HJ (3.05%) than in HD (1.55%), though the difference was not statistically significant ( = .54). Reflux gastritis in the HD was 8.83% while that from the HJ was 0.87%. Meta-analysis favored HJ (odds ratio [OR]: 20.38, 95% confidence interval [CI]: 4.24 to 97.94; = .002). For the mean operative time, Pooled Mean difference (MD: -56.93; 95% CI: -66.11, -45.75; = .00001) was significant favoring HD. Outcomes such as hospital stay, bile leak, anastomotic stricture, bleeding, reoperation rate, and adhesive obstruction were comparable.

[CONCLUSION] Laparoscopic HD and HJ show comparable short-term safety after CDC excision, with no significant difference in bile leak or cholangitis. HD, however, carries a higher risk of bile reflux and gastritis, though the operative time is significantly shorter with HD, offering a technical advantage.