Growth in children with choledochal malformations: effect of the Roux loop
Purpose Excision and biliary reconstruction using a Roux loop is the current standard for choledochal malformation (CM). This is un-physiological, delivering bile beyond the duodenum and excluding a significant length of the jejunum from intestinal absorption. We investigated whether this had an eff...
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| Veröffentlicht in: | Pediatric surgery international 2015-11, Vol.31 (11), p.1015-1019 |
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| creator | Ford, Kathryn E. Cooper, Lilli R. L. Davenport, Mark |
| description | Purpose
Excision and biliary reconstruction using a Roux loop is the current standard for choledochal malformation (CM). This is un-physiological, delivering bile beyond the duodenum and excluding a significant length of the jejunum from intestinal absorption. We investigated whether this had an effect on post-operative growth.
Methods
Retrospective case-note analysis of children surgically treated for CM. Growth variables were converted to standard deviation scores (SDS) and compared against population norms.
P
|
| doi_str_mv | 10.1007/s00383-015-3759-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1722929678</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1722929678</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-c1c21db66caa0416c58f461fb7cf533881d2ab3306515c6f91ef13f6023fd4143</originalsourceid><addsrcrecordid>eNp1kE1LxDAURYMozvjxA9xIwI2bal7SpK07GfxkQBBdh0ya2ErbjEmLOr_ejFURwdWDvHNvkoPQAZATICQ7DYSwnCUEeMIyXiSrDTSFlGVJkQPbRFMCWZEQxvMJ2gnhmRCSM1FsowkVVIiMiym6vfLuta9w3WFd1U3pTYdf63igK9eY0ulKNbhVjXW-VX3tunCGjbVG99hZ3FcG37vhDTfOLffQllVNMPtfcxc9Xl48zK6T-d3Vzex8nug0pX2iQVMoF0JopUgKQvPcpgLsItOWM5bnUFK1YIwIDlwLW4CxwKwglNkyjd_bRcdj79K7l8GEXrZ10KZpVGfcECRklBa0EFke0aM_6LMbfBdf90kJShnjkYKR0t6F4I2VS1-3yr9LIHItWo6iZRQt16LlKmYOv5qHRWvKn8S32QjQEQhx1T0Z_-vqf1s_AC1vh_A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1722622335</pqid></control><display><type>article</type><title>Growth in children with choledochal malformations: effect of the Roux loop</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Ford, Kathryn E. ; Cooper, Lilli R. L. ; Davenport, Mark</creator><creatorcontrib>Ford, Kathryn E. ; Cooper, Lilli R. L. ; Davenport, Mark</creatorcontrib><description>Purpose
Excision and biliary reconstruction using a Roux loop is the current standard for choledochal malformation (CM). This is un-physiological, delivering bile beyond the duodenum and excluding a significant length of the jejunum from intestinal absorption. We investigated whether this had an effect on post-operative growth.
Methods
Retrospective case-note analysis of children surgically treated for CM. Growth variables were converted to standard deviation scores (SDS) and compared against population norms.
P
< 0.05 was significant.
Results
From 1994 to 2014, 135 children (<16 years) were identified. Median age at surgery was 3.3 (IQR 1.5–7) years. Morphology included: type 1 C
ystic
(
n
= 54, 40 %), type 1
Fusiform
(
n
= 58, 43 %) and type 4 (intra and extra-hepatic) (
n
= 22, 16 %). There was pre-operative growth failure [median weight SDS = −0.4 (−1.2 − 0.4),
P
= 0.0004] with a similar trend for height [SDS = −0.38 (−1.2 − 0.5),
P
= 0.08)]. This correlated with presentation bilirubin (
r
s
= −0.24,
P
= 0.004), GGT (
r
s
= −0.27,
P
= 0.002) and AST (
r
s
= −0.27,
P
= 0.002) but not morphology (
P
= 0.82) or presentation (
P
= 0.4). Median follow-up was 1.9 (0.6–4.7) years, during which time both height (
P
= 0.73) and weight (
P
= 0.45) reverted to normal.
Conclusion
This is the first report of growth in children with CM following a Roux-loop reconstruction and showed pre-operative growth failure probably attributed to a period of biliary obstruction but catch-up growth when corrected.</description><identifier>ISSN: 0179-0358</identifier><identifier>EISSN: 1437-9813</identifier><identifier>DOI: 10.1007/s00383-015-3759-z</identifier><identifier>PMID: 26266756</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Anastomosis, Roux-en-Y ; Bile Ducts - abnormalities ; Bile Ducts - physiopathology ; Bile Ducts - surgery ; Body Height - physiology ; Body Weight - physiology ; Child ; Child Development - physiology ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Medicine ; Medicine & Public Health ; Original Article ; Pediatric Surgery ; Pediatrics ; Retrospective Studies ; Surgery ; Treatment Outcome</subject><ispartof>Pediatric surgery international, 2015-11, Vol.31 (11), p.1015-1019</ispartof><rights>Springer-Verlag Berlin Heidelberg 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-c1c21db66caa0416c58f461fb7cf533881d2ab3306515c6f91ef13f6023fd4143</citedby><cites>FETCH-LOGICAL-c442t-c1c21db66caa0416c58f461fb7cf533881d2ab3306515c6f91ef13f6023fd4143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00383-015-3759-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00383-015-3759-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26266756$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ford, Kathryn E.</creatorcontrib><creatorcontrib>Cooper, Lilli R. L.</creatorcontrib><creatorcontrib>Davenport, Mark</creatorcontrib><title>Growth in children with choledochal malformations: effect of the Roux loop</title><title>Pediatric surgery international</title><addtitle>Pediatr Surg Int</addtitle><addtitle>Pediatr Surg Int</addtitle><description>Purpose
Excision and biliary reconstruction using a Roux loop is the current standard for choledochal malformation (CM). This is un-physiological, delivering bile beyond the duodenum and excluding a significant length of the jejunum from intestinal absorption. We investigated whether this had an effect on post-operative growth.
Methods
Retrospective case-note analysis of children surgically treated for CM. Growth variables were converted to standard deviation scores (SDS) and compared against population norms.
P
< 0.05 was significant.
Results
From 1994 to 2014, 135 children (<16 years) were identified. Median age at surgery was 3.3 (IQR 1.5–7) years. Morphology included: type 1 C
ystic
(
n
= 54, 40 %), type 1
Fusiform
(
n
= 58, 43 %) and type 4 (intra and extra-hepatic) (
n
= 22, 16 %). There was pre-operative growth failure [median weight SDS = −0.4 (−1.2 − 0.4),
P
= 0.0004] with a similar trend for height [SDS = −0.38 (−1.2 − 0.5),
P
= 0.08)]. This correlated with presentation bilirubin (
r
s
= −0.24,
P
= 0.004), GGT (
r
s
= −0.27,
P
= 0.002) and AST (
r
s
= −0.27,
P
= 0.002) but not morphology (
P
= 0.82) or presentation (
P
= 0.4). Median follow-up was 1.9 (0.6–4.7) years, during which time both height (
P
= 0.73) and weight (
P
= 0.45) reverted to normal.
Conclusion
This is the first report of growth in children with CM following a Roux-loop reconstruction and showed pre-operative growth failure probably attributed to a period of biliary obstruction but catch-up growth when corrected.</description><subject>Anastomosis, Roux-en-Y</subject><subject>Bile Ducts - abnormalities</subject><subject>Bile Ducts - physiopathology</subject><subject>Bile Ducts - surgery</subject><subject>Body Height - physiology</subject><subject>Body Weight - physiology</subject><subject>Child</subject><subject>Child Development - physiology</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0179-0358</issn><issn>1437-9813</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1LxDAURYMozvjxA9xIwI2bal7SpK07GfxkQBBdh0ya2ErbjEmLOr_ejFURwdWDvHNvkoPQAZATICQ7DYSwnCUEeMIyXiSrDTSFlGVJkQPbRFMCWZEQxvMJ2gnhmRCSM1FsowkVVIiMiym6vfLuta9w3WFd1U3pTYdf63igK9eY0ulKNbhVjXW-VX3tunCGjbVG99hZ3FcG37vhDTfOLffQllVNMPtfcxc9Xl48zK6T-d3Vzex8nug0pX2iQVMoF0JopUgKQvPcpgLsItOWM5bnUFK1YIwIDlwLW4CxwKwglNkyjd_bRcdj79K7l8GEXrZ10KZpVGfcECRklBa0EFke0aM_6LMbfBdf90kJShnjkYKR0t6F4I2VS1-3yr9LIHItWo6iZRQt16LlKmYOv5qHRWvKn8S32QjQEQhx1T0Z_-vqf1s_AC1vh_A</recordid><startdate>20151101</startdate><enddate>20151101</enddate><creator>Ford, Kathryn E.</creator><creator>Cooper, Lilli R. L.</creator><creator>Davenport, Mark</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20151101</creationdate><title>Growth in children with choledochal malformations: effect of the Roux loop</title><author>Ford, Kathryn E. ; Cooper, Lilli R. L. ; Davenport, Mark</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-c1c21db66caa0416c58f461fb7cf533881d2ab3306515c6f91ef13f6023fd4143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Anastomosis, Roux-en-Y</topic><topic>Bile Ducts - abnormalities</topic><topic>Bile Ducts - physiopathology</topic><topic>Bile Ducts - surgery</topic><topic>Body Height - physiology</topic><topic>Body Weight - physiology</topic><topic>Child</topic><topic>Child Development - physiology</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ford, Kathryn E.</creatorcontrib><creatorcontrib>Cooper, Lilli R. L.</creatorcontrib><creatorcontrib>Davenport, Mark</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric surgery international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ford, Kathryn E.</au><au>Cooper, Lilli R. L.</au><au>Davenport, Mark</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Growth in children with choledochal malformations: effect of the Roux loop</atitle><jtitle>Pediatric surgery international</jtitle><stitle>Pediatr Surg Int</stitle><addtitle>Pediatr Surg Int</addtitle><date>2015-11-01</date><risdate>2015</risdate><volume>31</volume><issue>11</issue><spage>1015</spage><epage>1019</epage><pages>1015-1019</pages><issn>0179-0358</issn><eissn>1437-9813</eissn><abstract>Purpose
Excision and biliary reconstruction using a Roux loop is the current standard for choledochal malformation (CM). This is un-physiological, delivering bile beyond the duodenum and excluding a significant length of the jejunum from intestinal absorption. We investigated whether this had an effect on post-operative growth.
Methods
Retrospective case-note analysis of children surgically treated for CM. Growth variables were converted to standard deviation scores (SDS) and compared against population norms.
P
< 0.05 was significant.
Results
From 1994 to 2014, 135 children (<16 years) were identified. Median age at surgery was 3.3 (IQR 1.5–7) years. Morphology included: type 1 C
ystic
(
n
= 54, 40 %), type 1
Fusiform
(
n
= 58, 43 %) and type 4 (intra and extra-hepatic) (
n
= 22, 16 %). There was pre-operative growth failure [median weight SDS = −0.4 (−1.2 − 0.4),
P
= 0.0004] with a similar trend for height [SDS = −0.38 (−1.2 − 0.5),
P
= 0.08)]. This correlated with presentation bilirubin (
r
s
= −0.24,
P
= 0.004), GGT (
r
s
= −0.27,
P
= 0.002) and AST (
r
s
= −0.27,
P
= 0.002) but not morphology (
P
= 0.82) or presentation (
P
= 0.4). Median follow-up was 1.9 (0.6–4.7) years, during which time both height (
P
= 0.73) and weight (
P
= 0.45) reverted to normal.
Conclusion
This is the first report of growth in children with CM following a Roux-loop reconstruction and showed pre-operative growth failure probably attributed to a period of biliary obstruction but catch-up growth when corrected.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26266756</pmid><doi>10.1007/s00383-015-3759-z</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0179-0358 |
| ispartof | Pediatric surgery international, 2015-11, Vol.31 (11), p.1015-1019 |
| issn | 0179-0358 1437-9813 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1722929678 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Anastomosis, Roux-en-Y Bile Ducts - abnormalities Bile Ducts - physiopathology Bile Ducts - surgery Body Height - physiology Body Weight - physiology Child Child Development - physiology Child, Preschool Female Follow-Up Studies Humans Infant Male Medicine Medicine & Public Health Original Article Pediatric Surgery Pediatrics Retrospective Studies Surgery Treatment Outcome |
| title | Growth in children with choledochal malformations: effect of the Roux loop |
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