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Single Port Laparoscopic Assisted Cholangiogram for Suspected Biliary Atresia (Abstract)

Iftikhar A Jan, Anwarul Haq, Mudassar Gondal, Ubaidullah Khan, Mohammad Asif,

Department of Pediatric Surgery, The Children’s Hospital, PIMS

Islamabad, Pakistan

 

Abstract

Background: Early diagnosis in babies with suspected biliary atresia is important for better outcome of definitive surgery. The most reliable investigation is Cholangiogram which gives an accurate diagnosis of biliary atresia in most cases. Laparoscopic assisted cholangiogram has now replaced the open cholangiogram to achieve this goal.

Materials and Methods: We performed Single Port Laparoscopic Assisted Cholangiogram (SPLAC) in ten babies with suspected BA where other investigations failed to confirm the diagnosis. In babies with good passage of contrast in the duodenum trucut liver biopsy was also performed under laparoscopic vision.

Results: Biliary atresia was confirmed in 5 babies. Of the other five babies, four had neonatal hepatitis and one had biliary hyoplasia confirmed by liver biopsy. In one patient we needed a second port for liver retraction for visualization of gall bladder. In another baby the contrast was injected in the peri-gall bladder area and needed exploration. He had neonatal hepatitis. Two babies had excessive bleeding from the trucut biopsy site. One needed blood transfusion and other fresh frozen plasma and both revived.

Conclusions: Single port Laparoscopic Assisted Cholangiogram is thus a reliable modality for the diagnosis of biliary atresia. Trucut biopsy however may be performed with caution and after appropriate correction of any coagulopathy as babies may be more prone to bleed from the biopsy site due to pneumo-peritoneum and deranged coagulation profile.

Key words: Biliary atresia, diagnosis, single port, Cholangiogram

 

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