Clinical PaperThe timing of surgery of antenatally diagnosed choledochal malformations: A descriptive analysis of a 26-year nationwide cohort

IntroductionCholedochal 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.MethodsUsing 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.ResultsBetween 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 (the series median) showed more short-term complications (66%) when compared to patients > 5.6 kg (0%, p = 0.02).ConclusionWhen not symptomatic within the first days of life, the majority 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.Levels of evidenceLevel III.