title: Different techniques for biliary diversion in progressive familial intrahepatic cholestasis.
abstract: BACKGROUND
  Progressive familial intrahepatic cholestasis (PFIC) is a cholestatic liver disease of childhood. Pruritus resulting from increased bile salts in serum might not respond to medical treatment, and internal or external biliary drainage methods have been described. In this study, we aimed to evaluate different internal drainage techniques in patients with PFIC.
  
  
  METHODS
  Between 2009 and 2014, seven children (4 male, 3 female, 3months-5years old), (median 2years of age) with PFIC were evaluated. The patients were reviewed according to age, gender, complaints, surgical technique, laboratory findings and outcome. In each two patients, cholecystoileocolonic anastomosis, cholecystojejunocolonic anastomosis and cholecystocolostomy were performed. Cholecysto-appendico-colonic anastomosis was the technique used in one patient.
  
  
  RESULTS
  Jaundice and excessive pruritus were the main complaints. One of the patients with cholecystoileocolonic anastomosis died of comorbid pathologies (cirrhosis, adhesive obstruction and severe sepsis). Temporary rectal bleeding was observed in all the patients postoperatively. Regardless of the surgical technique, pruritus was dramatically decreased in all the patients in the postoperative period.
  
  
  CONCLUSIONS
  Regardless of the technique, internal biliary diversion methods are beneficial for the relief of pruritus in PFIC patients. Selection of the surgical method might vary depending on the surgeon's preference and the surgical anatomy of the gastrointestinal system of the patient.
authors.affiliation: Department of Pediatric Surgery, Ondokuz Mayis University, Samsun, Turkey. Electronic address: mithatgunaydin55@gmail.com.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gunaydin
authors.affiliation: Department of Pediatric Surgery, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Tander
authors.affiliation: Department of Pediatric Surgery, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Demirel
authors.affiliation: Department of Pediatric Gastroenterology, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Gonul
authors.initials: G
authors.lastname: Caltepe
authors.affiliation: Department of Pediatric Gastroenterology, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Ayhan Gazi
authors.initials: AG
authors.lastname: Kalayci
authors.affiliation: Department of Pediatric Gastroenterology, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Esra
authors.initials: E
authors.lastname: Eren
authors.affiliation: Department of Pediatric Surgery, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Unal
authors.initials: U
authors.lastname: Bicakcı
authors.affiliation: Department of Pediatric Surgery, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Riza
authors.initials: R
authors.lastname: Rizalar
authors.affiliation: Department of Pediatric Surgery, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Ender
authors.initials: E
authors.lastname: Ariturk
authors.affiliation: Department of Pediatric Surgery, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Ferit
authors.initials: F
authors.lastname: Bernay
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002675:Child, Preschool; D002780:Cholestasis, Intrahepatic / Q000150:complications / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D007223:Infant; D007422:Intestines / Q000601:surgery*; D008297:Male; D011537:Pruritus / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
keywords: Biliary diversion; Internal drainage; Progressive familial intrahepatic cholestasis; Pruritus