Document Detail

Diagnostic laparoscopy-assisted cholangiography in infants with prolonged jaundice.
MedLine Citation:
PMID:  16341535     Owner:  NLM     Status:  MEDLINE    
Cholangiography is often crucial for establishing the definitive cause of neonatal jaundice. We present our protocol for using laparoscopy-assisted cholangiography in infants with prolonged jaundice and discuss its benefits. Firstly, a 5 mm supra-umbilical trocar is introduced to create a port for a 0 degrees laparoscope. A 5 mm trocar is then inserted through a right subcostal incision to allow the liver and gallbladder to be visualized. If the gallbladder is of good size, the fundus is exteriorized through the right subcostal trocar site and a catheter is inserted into the gallbladder for cholangiography. If the gallbladder is atretic, the fundus is not exteriorized and a laparotomy is performed for open intraoperative cholangiography because the lumen of an atretic gallbladder is usually not fully patent and cholangiography through its exteriorized fundus often fails. We reviewed 18 jaundiced infants thought to have biliary atresia (BA) who had laparoscopy-assisted cholangiography. At laparoscopy, four patients had good sized gallbladders and minimal to mild liver fibrosis. They underwent cholangiography via the exteriorized fundus, and BA in two cases and biliary hypoplasia in two cases were identified. The remaining 14 had atretic gallbladders and varying degrees of liver fibrosis. Cholangiography via the exteriorized fundus was performed in one patient, but failed and converted to open cholangiography. Open intraoperative cholangiography identified BA in all 14 cases. All BA cases progressed to Kasai portoenterostomy directly after diagnosis. Laparoscopy is used to determine the type of cholangiography to be performed based on the appearance of the gallbladder and this simple, accurate, and safe protocol allows the anatomical structure of the biliary tree to be obtained accurately with minimal surgical intervention.
Tadaharu Okazaki; Go Miyano; Atsuyuki Yamataka; Hiroyuki Kobayashi; Hiroyuki Koga; Geoffrey J Lane; Takeshi Miyano
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Publication Detail:
Type:  Journal Article     Date:  2005-12-08
Journal Detail:
Title:  Pediatric surgery international     Volume:  22     ISSN:  0179-0358     ISO Abbreviation:  Pediatr. Surg. Int.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-31     Completed Date:  2006-06-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8609169     Medline TA:  Pediatr Surg Int     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  140-3     Citation Subset:  IM    
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, 113-8421, Bunkyo-ku, Tokyo, Japan.
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MeSH Terms
Bile Ducts / abnormalities
Biliary Atresia / complications,  diagnosis,  surgery
Cholangiography / methods*
Infant, Newborn
Jaundice, Neonatal / diagnosis*,  etiology,  surgery
Laparoscopy / methods*

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