Applycation of laparoscopy in the diagnosis and treatment of obstructive infantile cholestasis

Objective To study the use of laparoscopy in the diagnosis and treatment of obstructive infantile cholestasis. Methods The clinical data of 106 patients with obstructive infantile cholestasis from January 2012 to June 2017 were studied retrospectively. After two weeks of conservative treatments which failed to decrease the bilirubin levels significantly, these patients were subjected to laparoscopic diagnosis and treatment. Results A correct diagnosis was established in all these 106 patients by laparoscopic biliary tract exploration and cholangiography. Eighty-eight patients were diagnosed to have biliary atresia (83.0%), 16 patients inspissated bile syndrome (15.1%) and 2 patients biliary hypoplasia (1.9%). Thirty-eight of the 88 biliary atresia patients gave up operative treatment after laparoscopic biliary tract exploration and cholangiography. The remaining 50 biliary atresia patients were treated with open Kasai portoenterostomy. The prognosis of the biliary atresia patients were different from the non-biliary atresia patients. On follow-up for 4 months to 5 years, all the 18 non-biliary atresia patients were in good condition and there was no recurrence of jaundice after laparoscopic cholecystostomy and biliary tract irrigation. Conclusions The laparoscopic minimally invasive technique helped to establish diagnosis and treatment in patients with obstructive infantile cholestasis. For patients with biliary atresia, this procedure gave a definitive diagnosis and offered an opportunity for surgery. For patients with inspissated bile syndrome and biliary hypoplasia patients, laparoscopic cholecystostomy and biliary tract irrigation established the correct diagnosis and reduced liver damage resulted by cholestasis. Key words: Laparoscopy; Biliary tract surgical procedure; Biliary tract diseases; Biliary atresia; Infant, newborn, disease