Research Article
Laparoscopy-Assisted Percutaneous Cholangiography in
Biliary Atresia Diagnosis: Comparison with Open Technique
Murat Alkan,
1
Kamuran Tutus,
1
Ender FakJoglu,
1
Onder Ozden,
1
Zehra Hatipoglu,
2
Serdar Hilmi Iskit,
1
Recep Tuncer,
1
and Unal Zorludemir
1
1
Department of Pediatric Surgery, Cukurova University Faculty of Medicine, Adana, Turkey
2
Department of Anesthesiology, Cukurova University Faculty of Medicine, Adana, Turkey
Correspondence should be addressed to Murat Alkan; drmuratalkan@gmail.com
Received 15 January 2015; Accepted 28 July 2015
Academic Editor: Colin Knight
Copyright © 2016 Murat Alkan et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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 benefts of the laparoscopy-assisted cholangiography and compare it to the traditional
procedure via laparotomy. Patients and Method. Te medical records of the cases who had undergone cholangiography for
prolonged jaundice between 2007 and 2014 were analyzed. Te patients were grouped according to cholangiography technique
(laparotomy/laparoscopy). Te 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.
1. Introduction
Prolonged jaundice is defned as jaundice longer than 14 days
in term infants and 21 days in preterm infants. Over this
period, prolonged jaundice with conjugated hyperbilirubine-
mia in a newborn with pale stool and dark urine alerts the
pediatrician to investigate the cholestatic disorders such as
infections due to congenital rubella, CMV, toxoplasmosis,
and endocrine and metabolic disorders as hypothyroidism,
alpha-1-antitrypsin defciency, and aminoaciduria. Afer all
these investigations, ultrasonography, hepatic scintigraphy,
and usually liver biopsy take place. In cases of no diag-
nosis despite these investigations, surgical exploration is
usually needed to exclude biliary atresia. Cholangiography
via laparotomy or laparoscopy has remained as the gold
standard for the diagnosis of biliary atresia. Invasiveness
and high morbidity of explorative procedure generally make
pediatricians refer the patient to the pediatric surgeon afer
their investigations exclude all nonsurgical causes of jaundice.
On the other hand, early identifcation of biliary atresia afects
the success rate of the operation and improves the outcome
[1].
Laparoscopy is a minimally invasive procedure that can
exclude surgical causes of jaundice and may help avoid
unnecessary laparotomy in neonates.
Herein, we present our technique, laparoscopy-assisted
percutaneous cholangiography with liver biopsy with a single
umbilical trocar, and compared the results of this technique
with traditional open surgical explorative cholangiography
and liver biopsy.
2. Patients and Method
We performed a retrospective chart review of all infants
who were referred between December 2007 and December
Hindawi Publishing Corporation
Gastroenterology Research and Practice
Volume 2016, Article ID 5637072, 5 pages
http://dx.doi.org/10.1155/2016/5637072