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Clinical comparison between the presence and absence of protein plugs in pediatric choledochal cysts: experience in 390 patients over 30 years in a single center

Authors
Oh, ChaeyounCheun, Jong-HoKim, Hyun-Young
Issue Date
Nov-2021
Publisher
대한외과학회
Keywords
Child; Choledochal cyst; Pediatrics; Protein plug
Citation
Annals of Surgical Treatment and Research, v.101, no.5, pp 306 - 313
Pages
8
Indexed
SCIE
SCOPUS
KCI
Journal Title
Annals of Surgical Treatment and Research
Volume
101
Number
5
Start Page
306
End Page
313
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/54782
DOI
10.4174/astr.2021.101.5.306
ISSN
2288-6575
2288-6796
Abstract
Purpose: The incidence of choledochal cyst (CC) with protein plugs is between 15.5%-40.4%. However, studies on CCs with protein plugs in children are limited. We aimed to analyze the clinical features, surgical findings, and complications of pediatric CCs with and without protein plugs. Methods: We retrospectively analyzed 390 patients who underwent surgery for CCs between January 1987 and September 2017. The patients were divided into 2 groups: groups A (CC with protein plugs) and B (CC without protein plugs). The presence of protein plugs was evaluated using preoperative images or identified during surgery. Results: One hundred forty-two (36.4%) patients had protein plugs in the pancreaticobiliary duct. The most common initial clinical presentation was abdominal pain, and its incidence was significantly higher in group A (66.2%) than in group B (54.8%) (P = 0.032). The incidence of accompanying pancreatitis was also significantly higher in group A (37.3% vs. 27.0%) (P = 0.040). Anomalous pancreaticobiliary ductal union (APBDU) was found in 261 patients (66.9%) and its incidence was significantly higher in group A (74.6% vs. 62.5%) (P = 0.014). Most protein plugs were found in the cyst (88.0%) and common channel (31.7%). The incidence of early complications was higher in group A; conversely, that of late complications did not differ. Conclusion: Approximately 36.4% of the pediatric CC patients were accompanied by protein plugs. Abdominal pain, pancreatitis, and APBDU were more commonly observed among those with protein plugs than among those without; long-term complications did not differ between them. [Ann Surg Treat Res 2021;101(5):306-313]
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Oh, Chae youn
Ansan Hospital (Department of Pediatric Surgery, Ansan Hospital)
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