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Jarruphong Noitumyae

Queen Sirikit National Institute of Child Health, Thailand

Presentation Title:

The pediatric choledochal cyst with hepatic duct stenosis: The state of the art in diagnosis and management

Abstract

The hepatic duct stenosis with choledochal developed post-operative hepatolithiasis and complications. Our systematic review and meta-analysis were included twenty published studies in 517 patients(575 sites). The meta-analysis revealed the locations were the confluence of the left and right hepatic ducts 54.65%(141 sites), the left or/and the right hepatic duct 34.45%(89 sites), and the segmental intrahepatic duct 5.04%(13 sites). These characteristics included a membranous/septum appearance(47.2%) and a circumferential/relative stenosis(52.7%). The preferred treatments were the wide hilar Roux-en Y hepaticojejunostomy(67.00%), the excision of membranes/septum(33.00%), and the mixed hepatic-ductoplasty(33.82%)(open technique 51.38%, and laparoscopic technique 48.62%). The outcomes revealed hepatolithiasis 8/408(1.96%) in hepatic-ductoplasty compared to the normal anastomoses 26/109(23.85%), no statistical differences of meta analysis in anastomosis stricture(standard anastomosis 6.42%, open hepatic-ductoplasty 6.70% and 1.31% in laparoscopy). There was a higher bile leakage incidence in laparoscopy(10.04%) compared to open technique(0.056%). The hepatic-ductoplasty during the definite operation is effective. The characteristics and location can indicate the appropriate procedures. So, the hepatic-ductoplasty prevents hepatolithiasis or hepatic dilatation but increased anastomosis stricture. For laparoscopy, It's may decreased anastomotic stricture without persistent dilatation but increased minor bile leakage.

Biography

Jarruphong Noitumyae has graduated in pediatric surgery from the royal college of Thai surgeons since 2017 and complete his clinical advance certificate of pediatric minimally invasive surgery from Nagoya University hospital. He is the Assistance Professor of department of surgery Queen Sirikit National Institute of Child Health, Bangkok, Thailand. He interests in pediatric minimally invasive surgery and has publications, especially in single site laparoscopic surgery or scarless surgery. He has been the member of the international pediatric endoscopic group or IPEG.