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Othman MY, Teh KH, Zahari Z. Biliary complications post liver resection for pediatric liver tumors. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000589. [PMID: 37441088 PMCID: PMC10335567 DOI: 10.1136/wjps-2023-000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Objective To review biliary complications following liver resection for liver tumors in children and their associated risk factors. Methods Retrospectively, we reviewed children who underwent liver resection for liver tumors from 2010 to 2019. Demographic data, operative details, types of complications, interventions and outcomes were studied. Results Eighty-six out of 108 liver resections were included in this study. The median age of patients was 1.8 years old, and 55% were male. The majority (95%) were malignant tumors, of which 87% were hepatoblastoma (n=71). The most common procedure performed was extended right hepatectomy (37%, n=32). Twelve (14%) patients had primary biliary complications: nine bile leakages and three biliary obstructions. Six cases of bile leakage were treated non-operatively with drainage only; however, one developed bilothorax. Three bile leakages underwent early operative intervention. Four patients underwent biliary reconstruction. Biliary complications were not significantly associated with age, sex, ethnicity or pathology of the tumor. Ten of them (83%) developed following extended hepatectomies (five right, five left), in which the left side had a higher rate of complications (63% vs 16%). None of the central hepatectomies had biliary complications. Biliary complication rates were significantly higher among those who had segmentectomy 1 (p=0.023). Conclusions Biliary complication is a significant morbidity following liver resection in children. Surgery is eventually required for complicated bile leakage and primary biliary strictures. Follow-up is mandatory since secondary biliary complications may occur after the initial resolution of bile leakage. The groups at high risk of developing biliary complications are extended left hepatectomies and segmentectomy 1.
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Affiliation(s)
- Mohd Yusran Othman
- Department of Paediatric Surgery, Hospital Tunku Azizah (Kuala Lumpur Women's and Children's Hospital, Ministry of Health Malaysia), Kuala Lumpur, Malaysia
| | - Kok Hoi Teh
- Department of Paediatrics, Hospital Tunku Azizah (Kuala Lumpur Women's and Children's Hospital, Ministry of Health Malaysia), Kuala Lumpur, Malaysia
| | - Zakaria Zahari
- Department of Paediatric Surgery, Hospital Tunku Azizah (Kuala Lumpur Women's and Children's Hospital, Ministry of Health Malaysia), Kuala Lumpur, Malaysia
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Han J, Qin H, Yang W, Cheng H, Chang X, Zhu Z, Feng J, Yang S, Chen Y, Wang H. Surgical treatment of postoperative intractable bile leakage after liver tumor surgery in children. Front Pediatr 2023; 11:1110042. [PMID: 37255570 PMCID: PMC10225512 DOI: 10.3389/fped.2023.1110042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/26/2023] [Indexed: 06/01/2023] Open
Abstract
Aim To summarize systematically our six-year experience in the surgical treatment of postoperative bile leakage after liver tumor surgery in children, and explore its reoperation approach and treatment effect. Methods The clinical data of 6 patients with postoperative bile leakage cured by surgery from January 2016 to January 2022 were reviewed retrospectively. Results Among the six pediatric patients with postoperative bile leakage cured by surgery, four were male (67%) and two were female (33%). All patients underwent complex segmentectomy. The median time to bile leakage was 14 days (range, 10 to 32), and the daily drainage volume was stable from 170 ml to 530 ml per day. After conservative treatment failed, four patients received biliary-enteric anastomosis (patients 1, 3, 4, and 6), and two patients received bilio-cholecyst anastomosis (patients 2 and 5). All six patients were successfully treated with reoperation, and five patients were alive and without recurrence, while one patient was lost to follow-up due to abandoned treatment. Conclusion Our study suggests that surgery is a reliable and effective treatment for postoperative intractable bile leakage in children undergoing complex segmentectomy. Bilioenteric anastomosis is the most common technique for bile leakage, and bilio-cholecyst anastomosis is a feasible and effective surgical approach. These findings have important implications for the management of postoperative complications in pediatric patients undergoing complex segmentectomy.
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Affiliation(s)
- Jianyu Han
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Hong Qin
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Wei Yang
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Haiyan Cheng
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xiaofeng Chang
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zhiyun Zhu
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jun Feng
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Shen Yang
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Huanmin Wang
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
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Sun R, Xu X, Zheng Q, Zhan J. Therapeutic Endoscopic Retrograde Cholangiopancreatography for Pediatric Hepato-Pancreato-Biliary Diseases: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:915085. [PMID: 35844750 PMCID: PMC9280719 DOI: 10.3389/fped.2022.915085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hepato-pancreato-biliary (HPB) disease has different causes and types between children and adults, which has been increasingly diagnosed in the pediatric group. Endoscopic retrograde cholangiopancreatography (ERCP) has been gradually considered as a therapeutic method in adults, while in pediatric patients, there are not many reports of its usage. This systematic review and meta-analysis aims to assess the use condition of therapeutic ERCP in the management of pediatric HPB diseases. METHODS This systematic literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane library databases to identify all relevant articles published from inception to February 2022 that evaluated therapeutic ERCP in pediatric patients with HPB diseases. The researchers included studies in which patients were less than 18 years old and underwent therapeutic ERCP procedures. A random-effects model was used to analyze the usage rate of therapeutic ERCP procedures, procedural success rates, adverse event rates, and the rate of different therapeutic procedures. Subgroup analysis, sensitivity analysis, and meta-regression were conducted to analyze the source of heterogeneity. RESULTS A total of 33 articles were included. After homogenization, the overall use of therapeutic interventions accounts for 77% [95% confidence interval (CI) 74-81%] of all ERCP procedures. After excluding outlier studies, the estimation success rate of the therapeutic procedure is 74% (95% CI 69-79%), and adverse event rate is 8% (95% CI 6-10%). In our study, stent placement is the most common procedure, which makes up 75% (95% CI 65-86%) of all therapeutic procedures. In addition, the usage proportion of sphincterotomy (ST), stone extraction/removal, bougienage/balloon dilation is, respectively, 46% (95% CI 39-53%), 34% (95% CI 31-38%), and 26% (95% CI 22-29%). CONCLUSION The ERCP procedure is gradually considered a therapeutic technique in pediatric patients, the proportion of therapeutic ERCP is 77% of total usage, which is increasing every year. Meanwhile, its success rate is relatively high. It reflects that this operation modality is promising in the treatment of HPB disorders and is gradually expanded as more branch technologies are being used. A variety of operations can be achieved through ERCP procedures, and more functions should be developed in the future. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022302911].
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Affiliation(s)
- Rongjuan Sun
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of General Surgery, Tianjin Children's Hospital, Tianjin, China
| | - Xiaodan Xu
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of General Surgery, Tianjin Children's Hospital, Tianjin, China
| | - Qipeng Zheng
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of General Surgery, Tianjin Children's Hospital, Tianjin, China
| | - Jianghua Zhan
- Department of General Surgery, Tianjin Children's Hospital, Tianjin, China
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Lange B, Adam R, Kähler G, Wessel LM, Kubiak R. Experience with Stent Placement for Benign Pancreaticobiliary Disorders in Children. J Laparoendosc Adv Surg Tech A 2019; 29:839-844. [DOI: 10.1089/lap.2018.0663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Bettina Lange
- Department of Pediatric Surgery, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany
| | - Rüdiger Adam
- Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany
| | - Georg Kähler
- Department of Central Interdisciplinary Endoscopy, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany
| | - Lucas M. Wessel
- Department of Pediatric Surgery, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany
| | - Rainer Kubiak
- Department of Pediatric Surgery, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany
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Busweiler LAD, Wijnen MHWA, Wilde JCH, Sieders E, Terwisscha van Scheltinga SEJ, van Heurn LWE, Ziros J, Bakx R, Heij HA. Surgical treatment of childhood hepatoblastoma in the Netherlands (1990-2013). Pediatr Surg Int 2017; 33:23-31. [PMID: 27730288 DOI: 10.1007/s00383-016-3989-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Achievement of complete surgical resection plays a key role in the successful treatment of children with hepatoblastoma. The aim of this study is to assess the surgical outcomes after partial liver resections for hepatoblastoma, focusing on postoperative complications, resection margins, 30-day mortality, and long-term survival. METHOD Chart reviews were carried out on all patients treated for hepatoblastoma in the Netherlands between 1990 and 2013. RESULTS A total of 103 patients were included, of whom 94 underwent surgery. Partial hepatectomy was performed in 76 patients and 18 patients received a liver transplant as a primary procedure. In 42 of 73 (58 %) patients, one or more complications were reported. In 3 patients, information regarding complications was not available. Hemorrhage necessitating blood transfusion occurred in 33 (45 %) patients and 9 (12 %) patients developed biliary complications, of whom 8 needed one or more additional surgical interventions. Overall, 5-year disease-specific survival was 82, 92 % in the group of patients who underwent partial hepatectomy, and 77 % in the group of patients who underwent liver transplantation. CONCLUSIONS Partial hepatectomy after chemotherapy in children with hepatoblastoma offers good chances of survival. This type of major surgery is associated with a high rate of surgical complications (58 %), which is not detrimental to survival.
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Affiliation(s)
- Linde A D Busweiler
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital-Academic Medical Center and VU Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Marc H W A Wijnen
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital-Academic Medical Center and VU Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.,Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jim C H Wilde
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital-Academic Medical Center and VU Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.,Department of Pediatric Surgery, University Hospital, Geneva, Switzerland
| | - Egbert Sieders
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - L W Ernest van Heurn
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joseph Ziros
- Department of Pediatric Oncology, Emma Children's Hospital-Academic Medical Center, Amsterdam, The Netherlands
| | - Roel Bakx
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital-Academic Medical Center and VU Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital-Academic Medical Center and VU Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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