The benefit of laparoscopic cholangiography in differential diagnosis of biliary atresia and a review of the literature

Abstract

The aim of this study was to discuss our clinical experience on laparoscopic cholangiography (LC) and to compare the open and LC. LC’s performed in our clinic between 2008-2013 for differential diagnosis of biliary atresia (BA) in cases of prolonged jaundice were evaluated retrospectively and compared with open access cholangiographies. The Kasai procedure was performed on all patients where BA was recognized. Cholangiography was applied to 15 patients (6 laparoscopic, 9 open) during this time. The mean age of the LC patients was 47.2 days (30-75), whereas the mean age of the open cholangiography patients was 75 days (60-105). The mean age of laparoscopic cholangiographies were significantly smaller than the mean age of open cholangiographies (p=0.016). From 6 LC’s, 3 patients had BA. From 9 open cholangiographies patients, 3 patients had BA. The mean time of length of stay of patients who underwent LC with no diagnosis of BA was 1.3 days (1-2 days) and they were discharged uneventfully for the further evaluation of their jaundice. However the mean time of hospital stay was 4.2 days (3-6 days) for open cholangiographies which are not BA. The mean length of hospital stay of patients who underwent LC is significantly shorter than the open cholangiographies in cases that the BA is excluded (p=0.019). In the literature there is limited data concerning LC’s in children. LC is an effective alternative method in the diagnosis of BA and avoids unnecessary laparotomy. The mean length of hospital stay is after LC is considerable less than the open cases in patients which BA is excluded. 

Keywords

• Biliary atresia
• Kasai
• Laparoscopic cholangiography
• Pediatric