Prospective Study
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World J Gastroenterol. Aug 14, 2014; 20(30): 10606-10612
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10606
Coagulopathy in a subtype of choledochal cyst and management strategy
Mei Diao, Long Li, Wei Cheng
Mei Diao, Long Li, Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, China
Wei Cheng, Department of Paediatrics and Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
Wei Cheng, Department of Surgery, Beijing United Family Hospital, Beijing 100015, China
Author contributions: Li L and Cheng W designed the study and revised the manuscript; Diao M designed the study, collected and analyzed the clinical data, wrote and revised the manuscript.
Correspondence to: Long Li, Professor, Department of Pediatric Surgery, Capital Institute of Pediatrics, 2 Ya Bao Road, Chao Yang District, Beijing 100020, China. lilong22@hotmail.com
Telephone: +86-10-85695669 Fax: +86-10-85628194
Received: February 28, 2014
Revised: March 23, 2014
Accepted: April 30, 2014
Published online: August 14, 2014
Processing time: 176 Days and 6.3 Hours
Abstract

AIM: To evaluated our management algorithm of the coagulopathy. We evaluated our management algorithm of the coagulopathy.

METHODS: Between October 2001 and January 2013, 160 CDC children with coagulopathy (fibrinogen, FIB < 2 g/L) were recruited. FIB ≥ 1 g/L is generally required for safe elective surgery. We used FIB level as an indicator when: (1) patients with FIB levels between 1-2 g/L underwent one-stage definitive operation; and (2) patients with FIB < 1 g/L underwent 3 d of medical treatment. Thereafter, those with FIB ≥ 1 g/L underwent one-stage definitive operation whereas those with FIB < 1 g/L underwent external biliary drainage to allow liver function improvement. Those patients with liver function improvements underwent definitive operation after 7 d of drainage.

RESULTS: After preoperative optimization, 92.5% of CDC children with coagulopathy underwent successful one-stage definitive operation. The remaining 7.5% of CDC children required initial external bile drainage, and underwent definitive operation 11 d after the admission. The mean operative time and postoperative recovery duration were comparable to those with normal coagulations. The median follow-up period was 57 mo. No blood transfusion or other postoperative complications were encountered.

CONCLUSION: Following our management protocol, the majority of CDC children with coagulopathy can be managed with one-stage definitive operation.

Keywords: Choledochal cysts; Hepatic dysfunction; Coagulopathy; Hepaticojejunostomy; Laparoscopy; Children

Core tip: Children suffering from choledochal cysts with coagulopathy have increased operative risks. We assessed the coagulation profiles in children with different subtypes of choledochal cyst, and established a management strategy whereby patients underwent either medical optimization or laparoscopic external drainage before definitive laparoscopic operation. The results suggest that the treatment protocol allows safe one-stage definitive operation for the majority of choledochal cyst children with coagulopathy, and maximizes the opportunity of definitive operation.