Laparoscopic hepatojejunostomy for biliary atresia.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the feasibility of laparoscopic hepatojejunostomy for types I and II biliary atresia (BA). MATERIALS AND METHODS: Between April 2003 and July 2007, 10 children with "correctable" types I and II BA were enrolled for the study. They presented with progressive jaundice, pale stools, and elevated aspartate transferase and alanine transferase levels. There were 6 girls and 4 boys, with ages ranging from 23 to 160 days (median,53). All BA had cysts of extrahaptic bile ducts. There were 6 type I and 4 were type II BA. The median diameter of the cysts was 1.5 cm (range, 1.0-1.8). All 10 children underwent laparoscopic cyst excision with Roux-en-Y hepatojejunostomy. Four trocars were inserted. The distal end of the cyst was resected.and a Rouxen-Y hepatojejunostomy was fashioned. The patients were followed up on median for 26 months (range, 4-51). RESULTS: The median duration of the operation was 3.0 hours (range, 2.4 - 3.2). There were no intraoperative complications. The blood loss was between 5 to 10 mL. Postoperatively, patients passed flatus after 18 hours(range, 16-28), and resumed oral intake in 20 hours (range, 16-30). Normal colored stools were passed after 3 days (range, 2-4). Jaundice started to disappear on postoperative day 10 (range, 7-16). In 6 cases, the total and the direct bilirubin were normalized on postoperative day 14-3 in 3 weeks. One patient had a persistent elevation of bilirubin. The postoperative course was uneventful in all patients. The median postoperable hospital stay was 7 days (range, 5-9). No postoperative complication was found at the follow-up visits. CONCLUSIONS: The laparoscopic Kasai' operation for children with type I or II biliary atresia is feasible, safe, and effective.