One-staged or two-staged surgery for perforated choledochal cyst with bile peritonitis in children? A single center experience with 27 cases

To report the authors' experience in the management of perforated choledochal cyst with bile peritonitis (PCC) in children. Medical records of all children undergoing surgery for PCC at our hospital from May, 2005 to January, 2013 were reviewed. Twenty seven patients were identified, with a median age of 2 years. The clinical manifestations were abdominal pain (96.3 %), abdominal distention (92.6 %), vomiting (88.9 %), jaundice (74.1 %), fever (70.4 %), acholic stool (51.8 %), abdominal tenderness (92.6 %), peritoneal signs (74.1 %), and palpable mass (18.5 %). Duration of the acute symptoms ranged from 1 to 30 days (median 3 days). Median size of the choledochal cysts was 3 cm (range 1.5-18 cm). Before January 2008, four cases were treated by two-staged surgery and only one case by one-staged surgery. Since then, all remaining 22 cases were treated by the one-staged surgery. There was no anastomotic leakage and all patients were discharged in good health. The mean postoperative stay was 7.6 +/- A 2.5 days for the one-staged group. No complication was noted at a median follow-up of 24 months. One-staged definitive repair is feasible, safe and should be the treatment of choice for most cases of childhood PCC in experienced centers.