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

van den Eijnden MHA; de Kleine RH; de Blaauw I; Peeters PMJG; Koot BGP; Oomen MWN; Sloots CEJ; van Gemert WG; van der Zee DC; van Heurn LWE; Verkade HJ; Wilde JCH; Hulscher JBF

doi:10.1016/j.jpedsurg.2017.03.003

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Journal article

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

van den Eijnden MHA Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
de Kleine RH Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands.
de Blaauw I Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Peeters PMJG Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Koot BGP Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Oomen MWN Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
Sloots CEJ Department of Pediatric Surgery, University Medical Center Maastricht, Maastricht, The Netherlands.
van Gemert WG Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
van der Zee DC Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
van Heurn LWE Department of Pediatrics, University of Groningen, University Medical Center Groningen, University of Groningen, The Netherlands.
Verkade HJ University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland.
Wilde JCH Department of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.b.f.hulscher@umcg.nl.
Hulscher JBF

2017-03-21

Published in:

Journal of pediatric surgery. - 2017

English 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.

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