Timing of Prenatally Diagnosed Congenital Biliary Dilatation Surgery: A Retrospective Cohort Study.

BACKGROUND: To determine the impact of symptomatic status on perioperative outcomes and assess optimal surgical timing for asymptomatic children with prenatally diagnosed congenital biliary dilatation (CBD). METHODS: This retrospective cohort study analyzed prenatally diagnosed CBD cases from 2015 to 2024, classified as symptomatic or asymptomatic. Demographics, liver fibrosis grade, and perioperative outcomes were compared between groups. Then, asymptomatic patients were subdivided into early (≤ 30 days) and delayed (> 30 days) surgery groups for further comparison. RESULTS: Of the 574 patients, 305 were symptomatic and 269 were asymptomatic. The symptomatic group had a longer operative time [180.0 (150.0, 223.5) vs. 160.0 (133.0, 190.0) min, p < 0.001], higher incidence of liver fibrosis (34.1% vs. 24.2%, p = 0.019), longer drainage duration [4 (3.5) vs. 3 (3.4) days, p < 0.001], and longer postoperative stay [7 (6.9) vs. 7 (6.8) days, p < 0.001] compared with the asymptomatic group. Among asymptomatic infants, no significant differences were observed in operative time[154.0 (132.5, 197.0) vs. 160.0 (133.0, 190.0) min, p = 0.890] or short-term complications (p > 0.05) between the early and delayed surgery groups. However, all eight cases of stage F4 liver fibrosis occurred in the delayed surgery group. CONCLUSION: Surgery after symptom onset in prenatally diagnosed CBD increases fibrosis risk. Asymptomatic early surgery is safe and may reduce advanced fibrosis.