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 Grp

doi:10.1016/j.jpedsurg.2017.03.003

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 Grp

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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 10 days (1 day-2 months). 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 2.1 months resp. Postoperatively, four patients developed short-term complications and three developed long-term complications. Patients 5.6 kg (0%, p = 0.02).

Conclusion: When not symptomatic within the first days of life, themajority of children with antenatally detected CM remains asymptomatic. Surgery might safely be delayed to the age of 6 months or a weight of 6 kg. Postponing surgery in the clinically and biochemical asymptomatic patient might decrease the complication rate. (C) 2017 Elsevier Inc. All rights reserved.

Original language	English
Pages (from-to)	1156-1160
Number of pages	5
Journal	Journal of Pediatric Surgery
Volume	52
Issue number	7
DOIs	https://doi.org/10.1016/j.jpedsurg.2017.03.003
Publication status	Published - Jul 2017

Keywords

Choledochal malformation
Choledochal cysts
Antenatal diagnosis
BILIARY ATRESIA
POSTNATAL MANAGEMENT
PRENATAL-DIAGNOSIS
CYSTS
EXCISION
OUTCOMES
CHILDREN

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10.1016/j.jpedsurg.2017.03.003

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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., Sloots, C. E. J., van Gemert, W. G., van der Zee, D. C., van Heurn, L. W. E., Verkade, H. J., Wilde, J. C. H., Hulscher, J. B. F., & Netherlands Study Grp (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

@article{2c6409d47e0d4a7b9d559ce7ddf3f442,

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

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 10 days (1 day-2 months). 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 2.1 months resp. Postoperatively, four patients developed short-term complications and three developed long-term complications. Patients 5.6 kg (0%, p = 0.02).Conclusion: When not symptomatic within the first days of life, themajority of children with antenatally detected CM remains asymptomatic. Surgery might safely be delayed to the age of 6 months or a weight of 6 kg. Postponing surgery in the clinically and biochemical asymptomatic patient might decrease the complication rate. (C) 2017 Elsevier Inc. All rights reserved.",

keywords = "Choledochal malformation, Choledochal cysts, Antenatal diagnosis, BILIARY ATRESIA, POSTNATAL MANAGEMENT, PRENATAL-DIAGNOSIS, CYSTS, EXCISION, OUTCOMES, CHILDREN",

author = "{van den Eijnden}, {Maria H. A.} and {de Kleine}, {Ruben H.} and {de Blaauw}, Ivo and Peeters, {Paul M. J. G.} and Koot, {Bart G. P.} and Oomen, {Matthijs W. N.} and Sloots, {Cornelius E. J.} and {van Gemert}, {Wim G.} and {van der Zee}, {David C.} and {van Heurn}, {L. W. Ernest} and Verkade, {Henkjan J.} and Wilde, {Jim C. H.} and Hulscher, {Jan B. F.} and {Netherlands Study Grp}",

year = "2017",

month = jul,

doi = "10.1016/j.jpedsurg.2017.03.003",

language = "English",

volume = "52",

pages = "1156--1160",

journal = "Journal of Pediatric Surgery",

issn = "0022-3468",

publisher = "W B Saunders Co-Elsevier Inc",

number = "7",

}

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 & Netherlands Study Grp 2017, 'The timing of surgery of antenatally diagnosed choledochal malformations: A descriptive analysis of a 26-year nationwide cohort', Journal of Pediatric Surgery, vol. 52, no. 7, pp. 1156-1160. https://doi.org/10.1016/j.jpedsurg.2017.03.003

TY - JOUR

T1 - The timing of surgery of antenatally diagnosed choledochal malformations

T2 - A descriptive analysis of a 26-year nationwide cohort

AU - van den Eijnden, Maria H. A.

AU - de Kleine, Ruben H.

AU - de Blaauw, Ivo

AU - Peeters, Paul M. J. G.

AU - Koot, Bart G. P.

AU - Oomen, Matthijs W. N.

AU - Sloots, Cornelius E. J.

AU - van Gemert, Wim G.

AU - van der Zee, David C.

AU - van Heurn, L. W. Ernest

AU - Verkade, Henkjan J.

AU - Wilde, Jim C. H.

AU - Hulscher, Jan B. F.

AU - Netherlands Study Grp

PY - 2017/7

Y1 - 2017/7

N2 - 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 10 days (1 day-2 months). 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 2.1 months resp. Postoperatively, four patients developed short-term complications and three developed long-term complications. Patients 5.6 kg (0%, p = 0.02).Conclusion: When not symptomatic within the first days of life, themajority of children with antenatally detected CM remains asymptomatic. Surgery might safely be delayed to the age of 6 months or a weight of 6 kg. Postponing surgery in the clinically and biochemical asymptomatic patient might decrease the complication rate. (C) 2017 Elsevier Inc. All rights reserved.

AB - 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 10 days (1 day-2 months). 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 2.1 months resp. Postoperatively, four patients developed short-term complications and three developed long-term complications. Patients 5.6 kg (0%, p = 0.02).Conclusion: When not symptomatic within the first days of life, themajority of children with antenatally detected CM remains asymptomatic. Surgery might safely be delayed to the age of 6 months or a weight of 6 kg. Postponing surgery in the clinically and biochemical asymptomatic patient might decrease the complication rate. (C) 2017 Elsevier Inc. All rights reserved.

KW - Choledochal malformation

KW - Choledochal cysts

KW - Antenatal diagnosis

KW - BILIARY ATRESIA

KW - POSTNATAL MANAGEMENT

KW - PRENATAL-DIAGNOSIS

KW - CYSTS

KW - EXCISION

KW - OUTCOMES

KW - CHILDREN

U2 - 10.1016/j.jpedsurg.2017.03.003

DO - 10.1016/j.jpedsurg.2017.03.003

M3 - Article

C2 - 28318597

SN - 0022-3468

VL - 52

SP - 1156

EP - 1160

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

IS - 7

ER -