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- Title
Laparoscopic cholangiogram in biliary atresia: a refinement in the gallbladder hitch technique.
- Authors
Kishore, Ravi; Kisku, Sundeep M. C.; Thomas, Reju Joseph; Jeenipalli, Srinivasa Kishore
- Abstract
<bold>Introduction: </bold>The study describes a refinement in the gallbladder hitch stitch and assesses the value of the laparoscopic cholangiogram in children with suspected biliary atresia.<bold>Methods: </bold>Twenty children with neonatal jaundice and no drainage as shown on the HIDA scan underwent a diagnostic laparoscopy through an umbilical 5 mm port. A 3 mm laparoscopic needle holder inserted through a 3.5 mm port to the left of the umbilicus was used to hitch the gallbladder to the abdominal wall. The stylet of a large bore 16F IV cannula then was used to penetrate the gallbladder to perform the laparoscopic cholangiogram.<bold>Results: </bold>There was no need for conversion in all 20 children by this technique. Patent biliary anatomy was demonstrated in 11 children (11/20). These children had no further procedures. In 3 (3/20) children, the common bile duct was demonstrated, while the hepatic ducts were not. These children had a laparotomy for Kasai procedure after an open cholangiogram with a vascular bulldog clamp on the CBD confirmed the finding. Six (6/20) had no demonstrable patency; 3 had it confirmed when the abdomen was opened for the Kasai procedure; only those proceeding to Kasai portoenterostomy (3 hepatic duct atresia, 3 complete biliary atresias) had an epidural catheter placed by the anesthetist. The remaining 3 had no further procedure performed due to the advanced nodular liver with ascites and evidence of portal hypertension.<bold>Conclusion: </bold>The findings of laparoscopic cholangiogram were confirmed in all six children who underwent laparotomy for Kasai procedure. The laparoscopic cholangiogram using gallbladder hitch reliably demonstrates a patent biliary system (11/11) and was valuable in avoiding further invasive procedures in 70% (14/20) of babies.
- Subjects
BILIARY atresia; CHOLANGIOGRAPHY; LAPAROSCOPIC surgery; GALLBLADDER surgery; NEONATAL jaundice; THERAPEUTICS; ABDOMINAL surgery; GALLBLADDER; LAPAROSCOPY; SURGICAL anastomosis; DIAGNOSIS
- Publication
Pediatric Surgery International, 2018, Vol 34, Issue 4, p395
- ISSN
0179-0358
- Publication type
journal article
- DOI
10.1007/s00383-018-4236-2