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Oral Presentation - 58
Hepaticoduodenostomy or Hepaticojejunostomy ? Meta-analytic Evidence for Optimal Biliary Reconstruction Following Choledochal Cyst Excision in Children: A Systematic Review and Meta-Analysis from Pediatric Surgery Meta-Analysis Study Group (PESMA)
Mustafa Azizoğlu 1, Mehmet Hanifi Okur 2, Sonia Perez Bertolez 3, Mehmet Şaban Korkmaz 4, Sergey Klyuev 5, Tahsin Onat Kamçı 6, Hasan Ökmen 7, Nitinkumar Borkar 8, Bahattin Aydoğdu 2, Maria Escolino 9, Hakkari Aydoğdu 10, Ciro Esposito 9, Annika Mutanen 11, Federica Pederiva 12, Martin Lacher 13
1 Esenyurt Necmi Kadioglu State Hospital, Dep of Pediatric Surgery, Istinye University, Dep of Stem Cell and Tissue Engineering & 3D Bioprinting, Istanbul, Turkey
2 Department of Pediatric Surgery, Faculty of Medicine Balıkesir Üniversity, Balıkesir, Turkey
3 Pediatric Surgery Departament. Hospital Sant Joan de Déu. Barcelona. Spain.
4 Basaksehir Cam and Sakura City Hospital, Dep. of General Surgery, Istanbul, Turkey
5 AO GK MEDSI, Dep of Pediatric Surgery, Moscow, Russia
6 Bitlis Tatvan State Hospital
7 Esenyurt Necmi Kadioglu State Hospital, Dep of General Surgery Surgery, Istanbul, Turkey
8 Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
9 Federico II University, Department of Pediatric Surgery, Naples, Italy
10 Dicle University, Department of Pediatric Surgery, Diyarbakır, Turkey
11 Department of Pediatric Surgery, the New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
12 Pediatric Surgery, "F. Del Ponte" Hospital, ASST Settelaghi, Varese, Italy
13 University of Leipzig, Department of Pediatric Surgery, Leipzig, Germany.
Aim:This study aims to compare hepaticoduodenostomy (HD) and hepaticojejunostomy (HJ) in pediatric patients undergoing choledochal cyst excision, through a systematic review and meta-analysis, to determine the optimal biliary reconstruction technique based on postoperative complications, long-term outcomes, and surgical safety.
Methods:A comprehensive literature search was conducted across PubMed, Web of Science, EMBASE, SCOPUS, and Google Scholar from inception to June 2025. HD and HJ performed alongside choledochal cyst excision were compared. Review Manager 5.4 software was used for the analysis. Based on the I² statistic, either a random-effects or fixed-effects model was applied accordingly.
Results:After removing duplicates and irrelevant studies, 19 studies were deemed eligible for inclusion. A total of 16 studies, including 568 patients who underwent HD and 479 patients who underwent HJ, reported postoperative cholangitis rate. No significant difference was found between groups regarding postoperative cholangitis rate (4.7% vs 5.2%) (I²=12%) (OR:1.12, 95%CI:0.57-2.22; p=0.74). A total of 11 studies, including 465 patients who underwent HD and 416 patients who underwent HJ, reported postoperative biliary reflux rate. A higher incidence of biliary reflux was observed in the HD group than HJ group (6.6%, vs 0.5%) (I²=22%) (OR:9.64, 95%CI:3.61-25.73; p<0.00001). A total of 9 studies, including 236 patients who underwent HD and 203 patients who underwent HJ, reported postoperative adhesive small bowel obstruction (ASBO) rate. A lower incidence of ASBO was observed in the HD group than HJ group (0.4% vs 6.4%) (I²=0%) (OR:0.25, 95%CI:0.09-0.73; p=0.01).
Conclusions:This meta-analysis reveals no significant difference in cholangitis rates between HD and HJ. However, HD is associated with higher biliary reflux, while HJ shows a higher risk of adhesive small bowel obstruction. Further RCTs are needed to validate these results.
Hepatikoduodenostomi mi Yoksa Hepatikojejunostomi mi? Çocuklarda Koledok Kist Eksizyonu Sonrası Optimal Bilier Rekonstrüksiyon İçin Meta-Analitik Kanıt: Pediatrik Cerrahi Meta-Analiz Çalışma Grubu (PESMA) Sistematik Derleme ve Meta-Analizi
Mustafa Azizoğlu 1, Mehmet Hanifi Okur 2, Sonia Perez Bertolez 3, Mehmet Şaban Korkmaz 4, Sergey Klyuev 5, Tahsin Onat Kamçı 6, Hasan Ökmen 7, Nitinkumar Borkar 8, Bahattin Aydoğdu 2, Maria Escolino 9, Hakkari Aydoğdu 10, Ciro Esposito 9, Annika Mutanen 11, Federica Pederiva 12, Martin Lacher 13
1 Esenyurt Necmi Kadioglu State Hospital, Dep of Pediatric Surgery, Istinye University Dep of Stem Cell, and Tissue Engineering & 3D Bioprinting, Istanbul, Turkey
2 Balıkesir Üniversitesi Çocuk Cerrahisi ABD
3 Pediatric Surgery Departament. Hospital Sant Joan de Déu. Barcelona. Spain.
4 Basaksehir Cam and Sakura City Hospital, Dep. of General Surgery, Istanbul, Turkey
5 AO GK MEDSI, Dep of Pediatric Surgery, Moscow, Russia
6 Bitlis Tatvan Devlet Hastanesi
7 Esenyurt Necmi Kadioglu State Hospital, Dep of General Surgery Surgery, Istanbul, Turkey
8 Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
9 Federico II University, Department of Pediatric Surgery, Naples, Italy
10 Dicle University, Department of Pediatric Surgery, Diyarbakır, Turkey
11 Department of Pediatric Surgery, the New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
12 Pediatric Surgery, "F. Del Ponte" Hospital, ASST Settelaghi, Varese, Italy
13 University of Leipzig, Department of Pediatric Surgery, Leipzig, Germany.
Amaç: Bu çalışma, koledok kist eksizyonu yapılan pediatrik hastalarda hepatikoduodenostomi (HD) ile hepatikojejunostomi (HJ) tekniklerini sistematik derleme ve meta-analiz yoluyla karşılaştırarak, postoperatif komplikasyonlar, uzun dönem sonuçlar ve cerrahi güvenlik açısından en uygun bilier rekonstrüksiyon yöntemini belirlemeyi amaçlamaktadır.
Yöntem: PubMed, Web of Science, EMBASE, SCOPUS ve Google Scholar veri tabanlarında Haziran 2025’e kadar kapsamlı bir literatür taraması yapıldı. Çalışmamızda koledok kisti cerrahisinde HD ve HJ prosedürleri karşılaştırıldı. Analiz için Review Manager 5.4 programı kullanıldı. I² istatistiğine göre uygun şekilde random effects veya fixed effects modeli uygulandı.
Bulgular: Çalışmamıza toplamda 19 makale dahil edildi. Toplam 16 çalışmada, 568 HD ve 479 HJ hastasında postoperatif kolanjit oranı rapor edilmiştir. Postoperatif kolanjit oranı açısından gruplar arasında anlamlı fark saptanmadı (HD: %4.7, HJ: %5.2) (I²= 12%) (OR: 1.12, %95 GA: 0.57-2.22; p=0.74). Toplam 11 çalışmada, 465 HD ve 416 HJ hastasında postoperatif bilier reflü oranı rapor edilmiştir. HD grubunda HJ grubuna kıyasla daha yüksek bilier reflü insidansı saptandı (HD: %6.6, HJ: %0.5) (I²= 22%) (OR: 9.64, %95 GA: 3.61-25.73; p<0.00001). Toplam 9 çalışmada, 236 HD ve 203 HJ hastasında postoperatif adezif ince bağırsak obstrüksiyonu (ASBO) oranı rapor edilmiştir. HD grubunda HJ grubuna kıyasla daha düşük ASBO insidansı saptandı (HD: %0.4, HJ: %6.4) (I²= 0%) (OR: 0.25, %95 GA: 0.09-0.73; p=0.01).
Sonuç: Bu meta-analiz, HD ve HJ arasında postoperatif kolanjit oranları açısından anlamlı fark olmadığını ortaya koymaktadır. Ancak, HD ile daha yüksek bilier reflü riski; HJ ile ise daha yüksek adezif ince bağırsak obstrüksiyonu riski bulunmaktadır. Bu sonuçların doğrulanması için ileriye dönük randomize kontrollü çalışmalara ihtiyaç vardır.