The timing of surgery of antenatally diagnosed choledochal malformations: A descriptive analysis of a 26-year nationwide cohort

Maria H A van den Eijnden, Ruben H de Kleine, Ivo de Blaauw, Paul M J G Peeters, Bart G P Koot, Matthijs W N Oomen, Cornelius E J Sloots, Wim G van Gemert, David C van der Zee, L W Ernest van Heurn, Henkjan J Verkade, Jim C H Wilde, Jan B F Hulscher, Netherlands Study Group for Choledochus Cysts/Malformations (NeSCHoC)

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Abstract

INTRODUCTION: Choledochal malformations (CMs) are increasingly diagnosed antenatally. There is a dilemma between early surgery to prevent CM-related symptoms and postponing surgery to reduce complications. We aimed to identify the optimal timing of surgery in asymptomatic neonates with antenatally diagnosed CM and to identify predictors for development of symptoms.

METHODS: Using the Netherlands Study group on CHoledochal Cyst/malformation (NeSCHoc) we retrospectively collected demographic, biochemical and surgical data from all Dutch patients with an antenatally detected CM.

RESULTS: Between 1989 and 2014, antenatally suspected CM was confirmed in 17 patients at a median age of 10days (1day-2months). Four patients developed symptoms directly after birth (24%). Thirteen patients (76%) remained asymptomatic. Two of these progressed to symptoms before surgical intervention at 0.7 and 2.1months resp. Postoperatively, four patients developed short-term complications and three developed long-term complications. Patients <5.6kg (the series median) showed more short-term complications (66%) when compared to patients >5.6kg (0%, p=0.02).

CONCLUSION: When not symptomatic within the first days of life, the majority of children with antenatally detected CM remains asymptomatic. Surgery might safely be delayed to the age of 6months or a weight of 6kg. Postponing surgery in the clinically and biochemical asymptomatic patient might decrease the complication rate.

LEVELS OF EVIDENCE: Level III.

Original languageEnglish
Pages (from-to)1156-1160
Number of pages5
JournalJournal of Pediatric Surgery
Volume52
Issue number7
DOIs
Publication statusPublished - Jul 2017

Cite this

van den Eijnden, M. H. A., de Kleine, R. H., de Blaauw, I., Peeters, P. M. J. G., Koot, B. G. P., Oomen, M. W. N., ... Netherlands Study Group for Choledochus Cysts/Malformations (NeSCHoC) (2017). The timing of surgery of antenatally diagnosed choledochal malformations: A descriptive analysis of a 26-year nationwide cohort. Journal of Pediatric Surgery, 52(7), 1156-1160. https://doi.org/10.1016/j.jpedsurg.2017.03.003