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Eur J Pediatr Surg 2015; 25(05): 441-448
DOI: 10.1055/s-0034-1387947
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Controversies in Choledochal Malformations: A Survey among Dutch Pediatric Surgeons

Maria Hendrina Antoinette van den Eijnden
1   Department of Pediatric Surgery, University Medical Centre Groningen, Groningen, The Netherlands
,
Ruben H. de Kleine
2   Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
,
Henkjan J. Verkade
3   Department of Paediatrics, University Medical Center Groningen, Groningen, The Netherlands
,
Jim C. H. Wilde
4   Department of Pediatric Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
,
Paul M. J. G. Peeters
2   Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
,
Jan B. F. Hulscher
1   Department of Pediatric Surgery, University Medical Centre Groningen, Groningen, The Netherlands
› Author Affiliations
Further Information

Publication History

02 June 2014

03 July 2014

Publication Date:
26 October 2014 (online)

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Abstract

Background Choledochal malformation (CM) is a rare medical condition of which 80% are diagnosed in pediatric patients. There are several important controversies regarding diagnostic workup, management, and follow-up in these pediatric patients. To assess preferences and practices of Dutch pediatric surgeons regarding the diagnostic procedures, management, and follow-up of children with CM we conducted an electronic survey.

Methods A questionnaire was sent to all the pediatric surgeons working in the academic centers and the only community hospital with a pediatric surgery service. The questionnaire included, items regarding incidence, diagnostic workup, interval between diagnosis and surgery, surgical techniques, and follow-up. We also assessed whether personal exposure influenced the preferences and practices.

Results Overall 22 out of the 31 (71%) Dutch pediatric surgeons returned the questionnaire. Total 15 out of 22 (68%) encountered CM up to 2 times/y, whereas 7 out of 22 (32%) encountered it more than 2 times/y. Indications for surgery were significantly different between surgeons who encountered CM > 2 time/y versus those who did not: 6/6 (100%) of surgeons encountering CM > 2 times/y considered the presence of an asymptomatic CM an indication for surgery versus 5/14 (36%) of the pediatric surgeons who encountered a CM up to 2 times/y (p = 0.01). Overall 12 out of the 22 (55%) respondents preferred surgery between 6 months and 2 years of age. The amount of exposure did not differ in preferred age at surgery or surgical technique. In the symptomatic child 10/22 (45%) of respondents preferred surgery within 3 months. Overall 7/22 (32%) favored laparoscopic resection. Hepaticojejunostomy with Roux-en-Y reconstruction was the preferred reconstruction for all the respondents. One-third stated that they never performed a parenchyma resection. Follow-up was limited to 10 years in almost half of the respondents.

Conclusion Dutch pediatric surgeons demonstrate a wide variety of opinions regarding diagnostic workup, treatment, and follow-up of CM. While most surgeons encounter CM up to 2 times/y, there is an association between exposure and several of the outcome parameters. Some of the answers are not in line with the expert opinion. This demonstrates that there is a need for evidence-based (inter)national guidelines regarding the diagnostic approach, management, and follow-up.

Keywords

choledochal malformation - choledochal cysts - controversies in choledochal malformation - malformation
 

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