title: Laparoscopic cholecystocholangiography as an effective alternative exploratory laparotomy for the differentiation of biliary atresia.
abstract: OBJECTIVE
  Exploratory laparotomy with cholecystocholangiography is often performed for the definitive diagnosis of biliary atresia (BA) when radiological and biochemical studies are inconclusive. Laparoscopic cholecystocholangiography (LCC) has recently been introduced as an alternative procedure to avoid unnecessary laparotomy. We discuss the advantages and indications of LCC based on our experience of performing this diagnostic procedure in four infants with prolonged direct hyperbilirubinemia.
  
  
  METHODS
  We performed LCC in four infants by direct percutaneous puncture of the gallbladder by inserting a cholangiocatheter into the gallbladder or cystic duct. The decision to perform LCC was based on ultrasonography and computed tomography findings of an atrophic gallbladder with a patent lumen, although analysis of duodenal juice and hepatobiliary scintigraphy showed no sign of the excretion of bile into the small intestine.
  
  
  RESULTS
  In three infants, LCC did not show the entire biliary system, and laparotomy was necessary to confirm the diagnosis of BA. However, in the other patient LCC showed a normal biliary system and BA was excluded.
  
  
  CONCLUSIONS
  Laparoscopic cholecystocholangiography may be useful for the differential diagnosis of BA in patients with a patent gallbladder when imaging and biochemical findings are inconclusive. Furthermore, unnecessary exploratory laparotomy may be avoided in patients without BA.
authors.affiliation: Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Nose
authors.forename: Toshimichi
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Soh
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Takuya
authors.initials: T
authors.lastname: Kimura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fukuzawa
mesh_terms: D001656:Biliary Atresia / Q000175:diagnosis* / Q000601:surgery; D002765:Cholecystography; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D007813:Laparotomy