Abstract
Background
Recently, single definitive hepaticojejunostomy has been proposed to replace two-stage procedures, including initial urgent biliary drainage and final biliary reconstruction, with a reduced hospitalization time and corresponding overall hospitalization cost. We aimed to investigate the safety and efficacy of the initial definitive operation compared with the two-stage approach.
Methods
The medical records of patients with perforated CDCs managed between 2010 and 2017 were retrospectively reviewed. The qualified samples were divided according to a single definitive operation or two-stage approach. We conducted a comparison of the clinical characteristics, including surgical parameters, length of stay, and short- and intermediate-term complications.
Results
A total of 117 patients with perforated CDCs were reviewed, with 48 cases of single-stage management and 69 cases of two-stage management. No differences in the baseline characteristics between the two groups were found, such as age, sex distribution, ultrasound presentation, or laboratory findings. The initial definitive operation was associated with a lower total duration of drainage, including abdominal drainage and biliary drainage (p < 0.001), and rate of unplanned readmission (OR, 0.056; 95% CI 0.007–0.435; p < 0.001) than those who underwent two-stage management. Furthermore, the initial definitive operation significantly reduced the postoperative hospital stay (p < 0.001), and the overall hospitalization cost was accordingly reduced compared with two-stage management (p < 0.001).
Conclusions
The initial single definitive operation was safe and effective for most of the patients with perforated CDCs when expertise was available. Therefore, a single definitive operation should be considered the treatment of choice for perforated CDCs.
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Acknowledgements
We thank Prof. Lei Li for providing technical assistance and for insightful discussions during the preparation of the manuscript. We thank Dr **aoyong Zhang at the Wistar Institute, USA, for help with the linguistic revision of the manuscript.
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XW, FY and CG designed the study, analyzed the data and evaluated the manuscript. KG performed the statistical measurements and analyzed the data. CG and CY wrote the paper.
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The research was supported by the National Natural Science Foundation of China (Nos: 30973440, 30770950) and the key project of the Chongqing Natural Science Foundation (CSTC, 2008BA0021, cstc2012jjA0155).
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Wang, X., Gao, K., Yan, C. et al. Short- and intermediate-term evaluation of the initial definitive operation for perforated choledochal cysts compared to two-stage management. Eur J Trauma Emerg Surg 48, 1129–1135 (2022). https://doi.org/10.1007/s00068-020-01553-4
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DOI: https://doi.org/10.1007/s00068-020-01553-4