[Video-assisted treatment for biliary atresia].
BACKGROUND
The surgical treatment of biliary atresia is still a great challenge for pediatric surgeons. Kasai's operation usually needs a wide, painful, muscle-cutting laparotomies that quite often are followed by pain and peritoneal adhesion. These possible complications may disturb the post-operative course and humper liver transplantation. Advancements in minimally invasive surgery have allowed even the most complex procedures to be approached using these techniques.


METHODS
The authors present a case of successful Roux-en-Y laparoscopic portoenterostomy for the treatment of biliary atresia. We report a case of a 3-month-old patient with biliary atresia who weighted Kg 5,300 at the operation. The patient was placed in supine position. The procedure was performed with 4 trocars of 3 mm and 1 of 10 mm. The umbilical site was used for extracorporeal Roux-en-Y enteroenterostomy. CO2 was insufflated at a pressure of 8 mmHg and a flow of 0.5 L/min. A drain was placed through the lower trocar site with the tip near the anastomosis.


RESULTS
The procedure was free of neither intraoperative nor post-operative complications. Feeding by nasogastric tube was started after 2 days. Total oral feeding was possible after 8 days.


CONCLUSIONS
Laparoscopic approach to perform Kasai's operation is technically feasible and thanks to a magnified vision, it allows to abtain a good visualization of the portal structures with an adequate retraction of the liver. This procedure can avoid or decrease the post-operative complications such as pain, breathing difficulty, adhesions and resulting in very small scars. Anyway laparoscopic Kasaiportoenterostomy should be done by a surgeon with a good experience in laparoscopic hand-suturing and neonatal experience and with the support of an experienced in neonatal and infantile videosurgery anaesthesiologist.
Lima
M
M
Chirurgia Pediatrica, Universita degli Studi di Bologna. m.lima@med.unibo.it
Gargano
T
T
De Biagi
L
L
Ruggeri
G
G
Libri
M
M
Lopci
E
E
Salfi
N
N
Sciutti
R
R
Cecini
M T
MT
Landuzzi
V
V
D001656:Biliary Atresia / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D020535:Video-Assisted Surgery