To drain or not to drain in Roux-en-Y hepatojejunostomy for children with choledochal cysts in the laparoscopic era: a prospective randomized study.

BACKGROUND/PURPOSE: Routine drain placement after choledochal cyst (CDC) excision and Roux-en-Y hepatojejunostomy (RYHJ) is commonly practiced to predict and prevent bile/pancreatic leaks and hemorrhage. Recently, laparoscopic excision of CDC has decreased postoperative morbidity. The necessity of drainage has been questioned. We undertook a prospective randomized trial to assess the need for drainage.

METHOD: Between 2009 and 2011, 121 CDC children were randomized into 2 groups before the laparoscopic RYHJ: drainage group (n = 61) and nondrainage group (n = 60). Patients without severe cyst inflammation, perforated bile peritonitis, common/left/right hepatic duct strictures requiring ductoplasty, or distal cyst deeply embedded in pancreas were included. Normal activity resumption, postoperative hospital stay, complications, and pain scores were analyzed.

RESULTS

One hundred patients were recruited according to the selection criteria (drainage/nondrainage, 50/50). Normal activity resumption was significantly faster and the postoperative hospital stay was significantly shorter in the nondrainage group. The pain score in the drainage group was significantly higher. On postoperative days 2 and 3, 14% and 38% of the nondrainage group patients were pain free, whereas all the drainage group patients still suffered from pain (P < .01 and P < .001, respectively). The median follow-up period was 12.5 months in the drainage group and 12 months in the nondrainage group. None of the patients developed bile/pancreatic/intestinal leaks.

CONCLUSION

With the laparoscopic approach, no drainage is needed after RYHJ for the majority of CDC children in expert hands. It minimizes postoperative pain and complications, and facilitates recovery.