Abstract
Purpose
Exploratory laparotomy with cholecystocholangiography is often performed for the definitive diagnosis of biliary atresia (BA) when radiological and biochemical studies are inconclusive. Laparoscopic cholecystocholangiography (LCC) has recently been introduced as an alternative procedure to avoid unnecessary laparotomy. We discuss the advantages and indications of LCC based on our experience of performing this diagnostic procedure in four infants with prolonged direct hyperbilirubinemia.
Methods
We performed LCC in four infants by direct percutaneous puncture of the gallbladder by inserting a cholangiocatheter into the gallbladder or cystic duct. The decision to perform LCC was based on ultrasonography and computed tomography findings of an atrophic gallbladder with a patent lumen, although analysis of duodenal juice and hepatobiliary scintigraphy showed no sign of the excretion of bile into the small intestine.
Results
In three infants, LCC did not show the entire biliary system, and laparotomy was necessary to confirm the diagnosis of BA. However, in the other patient LCC showed a normal biliary system and BA was excluded.
Conclusion
Laparoscopic cholecystocholangiography may be useful for the differential diagnosis of BA in patients with a patent gallbladder when imaging and biochemical findings are inconclusive. Furthermore, unnecessary exploratory laparotomy may be avoided in patients without BA.
Article PDF
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Avoid common mistakes on your manuscript.
References
R Ohi (2001) ArticleTitleSurgery for biliary atresia Liver 21 175–82 Occurrence Handle10.1034/j.1600-0676.2001.021003175.x Occurrence Handle11422780
BE Wildhaber AG Coran RA Drongowski RB Hirschl JD Geiger JL Lelli et al. (2003) ArticleTitleThe Kasai portoenterostomy for biliary atresia: a review of a 27-year experience with 81 patients J Pediatr Surg 38 1480–5 Occurrence Handle10.1016/S0022-3468(03)00499-8 Occurrence Handle14577071
JL Santos CT Cerski VD Silva ES Mello MB Wagner TR Silveira (2002) ArticleTitleFactors related to the biliary atresia prognosis postportoenterostomy J Pediatr (Rio J) 78 341–6 Occurrence Handle10.1590/S0021-75572002000400015
JA Gubernick HK Rosenberg H Ilaslan AUS Kessler (2000) ArticleTitleApproach to jaundice in infants and children Radiographics 20 173–95 Occurrence Handle10682780
W Park S Choi H Lee (1999) ArticleTitleThe ultrasonographic “triangular cord” coupled with gallbladder images in the diagnostic prediction prediction of biliary atresia from infantile intrahepatic cholestasis J Pediatr Surg 34 1706–10 Occurrence Handle10.1016/S0022-3468(99)90650-4 Occurrence Handle10591576
HL Greene GL Helinek R Moran J O'Neill (1979) ArticleTitleA diagnostic approach to prolonged obstructive jaundice by 24-hour collection of duodenal fluid J Pediatr 95 412–4 Occurrence Handle469667
TS Jaw YT Kuo GC Liu SH Chen CK Wang (1999) ArticleTitleMR cholangiography in the evaluation of neonatal cholestasis Radiology 212 249–56 Occurrence Handle10405749
PJ McKiernan (2002) ArticleTitleNeonatal cholestasis Semin Neonatol 7 153–65 Occurrence Handle10.1053/siny.2002.0103 Occurrence Handle12208100
AA Shah AM Sitapara AV Shah (2002) ArticleTitleLaparoscopy in diagnosis of prolonged neonatal jaundice Indian Pediatr 39 1138–42 Occurrence Handle12522276
OF SenyüZ (2001) ArticleTitleYesildag‘, Emir H, Tekant G, Bozkurt P, Sarimurat N. Diagnostic laparoscopy in prolonged jaundice J Pediatr Surg 36 463–5 Occurrence Handle10.1053/jpsu.2001.21621 Occurrence Handle11226997
SA Hay HE Soliman HM Sherif AH Abdelrahman AA Kabesh AF Hamza (2000) ArticleTitleNeonatal jaundice: the role of laparoscopy J Pediatr Surg 35 1706–9 Occurrence Handle10.1053/jpsu.2000.19217 Occurrence Handle11101719
H Yamamoto M Yoshida S Ikeda H Terakura Y Sera (1994) ArticleTitleLaparoscopic cholecystocholangiography in a patient with biliary atresia Surg Laparosc Endosc 4 370–2 Occurrence Handle8000638
F Schier J Waldschmidt (1990) ArticleTitleExperience with laparoscopy for the evaluation of cholestasis in newborns Surg Endosc 4 13–4 Occurrence Handle10.1007/BF00591404 Occurrence Handle2138362
J Hirsig PP Rickham (1980) ArticleTitleEarly differential diagnosis between neonatal biliary atresia J Pediatr Surg 15 13–5 Occurrence Handle6445003
LL Leape ML Ramenofsky (1980) ArticleTitleLaparoscopy in children Pediatrics 66 215–20 Occurrence Handle6447270
K Georgeson (2003) ArticleTitleMinimally invasive surgery in neonates Semin Neonatol 8 243–8 Occurrence Handle10.1016/S1084-2756(03)00023-X Occurrence Handle15001143
M Royer P Mazuru S Kohan (1950) ArticleTitleBiliary kinesia studied by means of peritoneoscopic cholangiography Gastroenterology 16 83–90 Occurrence Handle14773717
LL Leape ML Ramenofsky (1977) ArticleTitleLaparoscopy in infants and children J Pediatr Surg 12 929–38 Occurrence Handle10.1016/0022-3468(77)90603-0 Occurrence Handle592073
RL Mayers LS Book MA O'Gorman KW White RB Jaffe PG Feola (2004) ArticleTitlePercutaneous cholecysto-cholangiography in the diagnosis of obstructive jaundice in infants J Pediatr Surg 39 16–18 Occurrence Handle10.1016/j.jpedsurg.2003.09.008 Occurrence Handle14694364
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nose, S., Hasegawa, T., Soh, H. et al. Laparoscopic Cholecystocholangiography as an Effective Alternative Exploratory Laparotomy for the Differentiation of Biliary Atresia. Surg Today 35, 925–928 (2005). https://doi.org/10.1007/s00595-005-3060-1
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00595-005-3060-1