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Background <p>Small hepatic duct opening diameter is an important cause of postoperative anastomotic stricture (PAS) following excision of cyst or extrahepatic bile duct for children with choledochal cyst (CC) or non-dilated pancreaticobiliary maljunction (PBM). We compared an embedded hepaticojejunostomy with flipping the end of hepatic duct outward (FHDO; modified anastomosis) to embedded hepaticojejunostomy (embedded anastomosis) and evaluated its feasibility in preventing PAS.</p> Methods <p>This retrospective study included CC or non-dilated PBM children with a small-diameter hepatic duct opening between January 2012 and July 2023. Further modified hepaticojejunostomy, comprising complete cyst or extrahepatic bile duct excision, mixed ductoplasty, embedding hepaticojejunostomy with FHDO, was performed via a laparoscopic or robotic approach. Clinical characteristics, operative parameters, and postoperative outcomes were compared.</p> Results <p>Of the 85 patients, 39 patients had Todani type I, 23 cases had Todani type IVa cysts, and 23 cases had non-dilated PBM. Thirty patients underwent embedded anastomosis, and fifty-five underwent modified anastomosis. There were no significant differences in gender, age at operation, and diameter of portal bile duct between two groups. Total operative time (<i>P</i> &lt; 0.001) and time for anastomosis (<i>P</i> = 0.034) were significantly longer in modified anastomosis group. Intraoperative blood loss, length of hospital stays, and intraoperative and postoperative complications were comparable between two groups. Time for anastomosis was significantly shorter with robotic surgery than with laparoscopic surgery in modified anastomosis group (<i>P</i> = 0.001). Further stratified analysis of patients with type I and type IVa CC revealed no significant difference in PAS rate between two groups, with one case of PAS in the embedded anastomosis group and no cases in the modified anastomosis group during follow-up.</p> Conclusions <p>Embedded hepaticojejunostomy with FHDO method is safe and feasible in CC or non-dilated PBM children with a small-diameter portal bile duct. Further multicenter studies with larger samples and longer follow-up are needed to confirm these findings.</p>

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Laparoscopic/robotic embedding hepaticojejunostomy with FHDO for biliary tract malformations with a small-diameter hepatic duct opening: a retrospective study

  • 期刊论文

  • 发表日期：

    2026年7月31日

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  • Jing-feng Tang,
  • Meng-xin Zhang,
  • Xi Zhang,
  • Shuiqing Chi,
  • Guoqing Cao,
  • Shuai Li,
  • Kang Li,
  • Yun Zhou,
  • Jin-xiang Zhang,
  • Shao-tao Tang

摘要

Background

Small hepatic duct opening diameter is an important cause of postoperative anastomotic stricture (PAS) following excision of cyst or extrahepatic bile duct for children with choledochal cyst (CC) or non-dilated pancreaticobiliary maljunction (PBM). We compared an embedded hepaticojejunostomy with flipping the end of hepatic duct outward (FHDO; modified anastomosis) to embedded hepaticojejunostomy (embedded anastomosis) and evaluated its feasibility in preventing PAS.

Methods

This retrospective study included CC or non-dilated PBM children with a small-diameter hepatic duct opening between January 2012 and July 2023. Further modified hepaticojejunostomy, comprising complete cyst or extrahepatic bile duct excision, mixed ductoplasty, embedding hepaticojejunostomy with FHDO, was performed via a laparoscopic or robotic approach. Clinical characteristics, operative parameters, and postoperative outcomes were compared.

Results

Of the 85 patients, 39 patients had Todani type I, 23 cases had Todani type IVa cysts, and 23 cases had non-dilated PBM. Thirty patients underwent embedded anastomosis, and fifty-five underwent modified anastomosis. There were no significant differences in gender, age at operation, and diameter of portal bile duct between two groups. Total operative time (P < 0.001) and time for anastomosis (P = 0.034) were significantly longer in modified anastomosis group. Intraoperative blood loss, length of hospital stays, and intraoperative and postoperative complications were comparable between two groups. Time for anastomosis was significantly shorter with robotic surgery than with laparoscopic surgery in modified anastomosis group (P = 0.001). Further stratified analysis of patients with type I and type IVa CC revealed no significant difference in PAS rate between two groups, with one case of PAS in the embedded anastomosis group and no cases in the modified anastomosis group during follow-up.

Conclusions

Embedded hepaticojejunostomy with FHDO method is safe and feasible in CC or non-dilated PBM children with a small-diameter portal bile duct. Further multicenter studies with larger samples and longer follow-up are needed to confirm these findings.