Laparoscopy-Assisted Percutaneous Cholangiography in Biliary Atresia Diagnosis: Comparison with Open Technique

Abstract

Introduction. Biliary atresia is a surgical cause of prolonged jaundice, which needs to be diagnosed with cholangiography that has traditionally been performed via laparotomy. Laparoscopic assistance has lately been introduced to avoid unnecessary laparotomy. We aim to evaluate the benefits of the laparoscopy-assisted cholangiography and compare it to the traditional procedure via laparotomy. Patients and Method. The medical records of the cases who had undergone cholangiography for prolonged jaundice between 2007 and 2014 were analyzed. The patients were grouped according to cholangiography technique (laparotomy/laparoscopy). The laparoscopy and laparotomy groups with patent bile ducts were focused and compared in terms of operation duration, postoperative initiation time of enteral feeding, and full enteral feeding achievement time. Results. Sixty-one infants with prolonged jaundice were evaluated between 2007 and 2014. Among the patients with patent bile ducts, operation duration, postoperative enteral feeding initiation time, and the time to achieve full enteral feeding were shorter in laparoscopy group. Conclusion. Laparoscopic cholangiography is safe and less time-consuming compared to laparotomy, with less postoperative burden. As early age of operation is a very important prognostic factor, laparoscopic evaluation should be an early option in work-up of the infants with prolonged jaundice with direct hyperbilirubinemia, for diagnosis/exclusion of biliary atresia.

Expedited Laparoscopic Cholangiogram and Liver Biopsy in the Workup of Biliary Atresia

“…They further conclude that MMP-7 may be helpful in the diagnosis of BA, but it is far from a new diagnostic "gold standard" (27). Surgical consultation may be delayed given the hesitancy from pediatric teams due to perceived morbidity of surgical intervention (28). At our institution, pediatric surgery is consulted for consideration of laparoscopic cholangiogram and laparoscopic liver biopsy after medical workup for hyperbilirubinemia has been initiated.…”

Protocols of Investigation of Neonatal Cholestasis—A Critical Appraisal

“…Inadvertently submitting an infant with Alagille syndrome to a Portoenterostomy based on a false-positive diagnosis of BA can lead to grievous prognostic consequences [ 52 , 53 ]. Technical optimization of cholangiography by radiologists and pediatric surgeons, be it intraoperative or laparoscopic, can increase the method’s accuracy, and avoid an unnecessary portoenterostomy [ 29 , 54 , 55 , 56 ].…”

Biliary atresia and congenital disorders of the extrahepatic bile ducts

“…A multicenter study concluded that duct/ductal bile plugs and portal stromal edema were the strongest independent histologic predictors of obstruction[ 17 ]. The sensitivity and specificity of histological findings are over 90%, although histopathological findings similar to those seen in BA may also be observed with other neonatal cholestasis diseases [such as alpha 1 antitrypsin deficiency, progressive familial intrahepatic cholestasis (PFIC), cystic fibrosis], though not necessarily in the early period[ 49 , 50 ]. The absence of an extrahepatic biliary tree in intraoperative cholangiography is, therefore, the leading indicator of BA[ 2 ].…”