Investigation of laparoscopic treatment for blliary atresia of type I or II

Abstract

Objective To investigate the feasibility and safety of laparoscopic Roux-en-Y hepatojejunostomy for curable biliary atresia(BA of type Ⅰ or Ⅱ). Methods From April 2003 to July 2007, the group enrolled 10 children suffering BA of type Ⅰ or Ⅱ with the manifestations of persistant jaundice, white stools and abnormal high level of AST and ALT. Six cases were girls, and 4 were boys. The mean age of patients were 53. 8 days (ranged from 23 days to 160 days). Six cases were diagnosed as type Ⅰ , and 4 with type Ⅱ, all of whose hepatic portal biliary tract were verified to have cystic dilatation by imaging examination, with the average diameter of 1.5 cm (ranged from 1.0 to 2.0 cm). After proved intraoperatively, the 10 children underwent laparoscopic cyst excision with Rouxen-Y hepatojejunostomy. All cases were followed up at a mean period of 26 months (ranged from 4 to 51 months). Results All cases were managed to perform laparoscopic operations without conversion to open laparotomy. Average duration of operations was 3.0 hours (ranging from 2.4 to 3.2 hours) without intraoperative complications, intraoperative bleeding was 5 to 10 ml without necessity for blood transfusion. The mean postoperative flatus time was 18 hours (ranging from 16 to 28 hours), postoperative oral food intake was 20 hours (ranged from 16 to 30 hours), bile stained stools were defecated on day 3 (ranged from 2 to 4 days) postoperatively. Abdominal drainage sustained at the average time of 58 hours (ranged from 48 to 72 hours). Jaundice appeared to reduce at day 10 (ranged from 7 to16 days) postoperatively. Total and direct bilirubin of 3 patients decreased to normal within 3 months. One infant with. the age of 5. 5 months died at 28 days after operation for hepatic failure caused by severe hepatic cirrhosis, although whose bile was well drained and bilirubin decreased once but elevated later again. ALT and AST of all patients decreased to different levels. The postoperative course was uneventful in other 9 patients with the hospital stay of 6. 8 days (ranged from 5 to 9 days) after operations. Data of follow-up showed no postoperative complication such as abnormal hepatic function, cholangitis, stoma stenosis or adhesive bowel obstruction, except one children got cholangitis 4 weeks after the operation who was then cured by anti-inflammatory treatment. Conclusions Laparoscopic cyst excision with Roux-en-Y hepatojejunostomy for children with type Ⅰ or Ⅱ biliary atresia is feasible, safe and effective. Key words: Biliary atresia; biliary cyst; Laparoscopes; Surgical procedures, minimally invasive