Background: Two commonly used hepato-biliary anastomosis after choledochal cyst excision are hepatico-duodenostomy (HD) and hepatico-jejunostomy (HJ). We discuss the early to medium term complications and outcomes in a cohort of 70 children.

Methods: A retrospective observational cohort study was undertaken of 70 children who presented with choledochal cysts between June 2007 and Jan 2014. Two cohorts depending on the type of anastomosis done to restore biliary continuity were analysed (HD and HJ). 

Results: Baseline characteristics were similar in both groups : HD and HJ. The HJ group had more unusual presentations that required surgery. Both groups had similar rates of individual complications - such as intestinal obstruction, pancreatitis, cholangitis, pancreatic leak, jaundice, pelvic abscess and wound infections. If all complications were combined, there was a 3.6 times greater chance to develop any complication in a HJ when compared to a HD. 

Conclusions: Early to intermediate follow up shows no significant difference between the two anastomosis in our series. Hepaticojejunostomy serves a versatile option for difficult biliary anatomy and unusual presentations though with a slightly higher complication rate. Though this may seem to favour the HD construct, a larger randomised trial will be required to answer this question.