PMID- 28051047
OWN - NLM
STAT- MEDLINE
DCOM- 20170901
LR  - 20191210
IS  - 0974-5998 (Electronic)
IS  - 0189-6725 (Print)
IS  - 0974-5998 (Linking)
VI  - 13
IP  - 4
DP  - 2016 Oct-Dec
TI  - Evaluation of the use of laparoscopic-guided cholecystocholangiography and liver 
      biopsy in definitive diagnosis of neonatal cholestatic jaundice.
PG  - 181-184
LID - 10.4103/0189-6725.194667 [doi]
AB  - BACKGROUND: Once it is established that a jaundiced infant has direct 
      hyperbilirubinemia, the principal diagnostic concern is to differentiate 
      hepatocellular from obstructive cholestasis. Traditional tests such as 
      ultrasonography, percutaneous liver biopsy and technetium 99 m hepatobiliary 
      iminodiacetic acid (HIDA) scan are often not sufficiently discriminating. 
      Definitive exclusion of biliary atresia (BA) in the infant with cholestatic 
      jaundice usually requires mini-laparotomy and intra-operative cholangiography. 
      This approach has many drawbacks because those sick infants are subjected to a 
      time-consuming procedure with the probability of negative surgical exploration. 
      AIM OF THE STUDY: The aim of this study was to determine the feasibility of 
      laparoscopic-guided cholecystocholangiography (LGCC) and its accuracy and safety 
      in the diagnosis of BA and thus preventing unnecessary laparotomy in infants 
      whose cholestasis is caused by diseases other than BA. PATIENTS AND METHODS: 
      Twelve cholestatic infants with direct hyperbilirubinemia subjected to LGCC (age, 
      7-98 days; mean, 56 days) after ultrasound scan and (99 mTc) HIDA scan and 
      percutaneous liver biopsy failed to provide the definitive diagnosis. RESULTS: 
      One patient had completely absent gall bladder (GB) so the laparoscopic procedure 
      was terminated and laparotomy was done (Kasai operation). Four patients had small 
      size GB; they underwent LGCC that showed patent common bile duct with atresia of 
      common hepatic duct, so laparotomy and Kasai operation was performed. Seven 
      patients had well-developed GB, LGCC revealed patent biliary tree, so 
      laparoscopic liver biopsies were taken for histopathology. Five of those patients 
      had neonatal hepatitis, and two had cholestasis as a complication of prolonged 
      TPN. No perioperative complications or mortalities were recorded. CONCLUSION: 
      When the diagnosis neonatal cholestasis remains elusive after traditional 
      investigations, LGCC is an accurate and simple method for differentiating BA from 
      hepatocellular causes.
FAU - Shreef, Khalid
AU  - Shreef K
AD  - Department of Pediatric Surgery, Zagazig University, Egypt; Department of 
      Pediatric Surgery, Asser Central Hospital and Abha Maternity Children Hospital, 
      Abha, Saudi Arabia.
FAU - Alhelal, Abdullah
AU  - Alhelal A
AD  - Department of Pediatric Surgery, Asser Central Hospital and Abha Maternity 
      Children Hospital, Abha, Saudi Arabia.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - India
TA  - Afr J Paediatr Surg
JT  - African journal of paediatric surgery : AJPS
JID - 101255062
SB  - IM
MH  - Biopsy/*methods
MH  - Cholangiography/*methods
MH  - Diagnosis, Differential
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Intraoperative Period
MH  - Jaundice, Neonatal/*diagnosis
MH  - Laparoscopy/*methods
MH  - Liver/*pathology
MH  - Male
MH  - Reproducibility of Results
MH  - Retrospective Studies
PMC - PMC5154223
COIS- There are no conflicts of interest.
EDAT- 2017/01/05 06:00
MHDA- 2017/09/02 06:00
PMCR- 2016/10/01
CRDT- 2017/01/05 06:00
PHST- 2017/01/05 06:00 [entrez]
PHST- 2017/01/05 06:00 [pubmed]
PHST- 2017/09/02 06:00 [medline]
PHST- 2016/10/01 00:00 [pmc-release]
AID - AfrJPaediatrSurg_2016_13_4_181_194667 [pii]
AID - AJPS-13-181 [pii]
AID - 10.4103/0189-6725.194667 [doi]
PST - ppublish
SO  - Afr J Paediatr Surg. 2016 Oct-Dec;13(4):181-184. doi: 10.4103/0189-6725.194667.