title: Laparoscopic cystojejunostomy for type I cystic biliary atresia in children.
abstract: OBJECTIVE
  The use of laparoscopy in the treatment of biliary atresia (BA) is still debated. We report our strategy using laparoscopy in type I cystic BA.
  
  
  METHODS
  We reviewed the records of patients treated for BA from 2002-2013. When the diagnosis was suspected, an ultrasound was performed. If it showed a cyst > 5 mm in the hilum with no patent gallbladder, we performed an initial explorative laparoscopy. In the case of a patent biliary tree above the cyst, a laparoscopic cystojejunostomy was performed. In cases of absent communication (type III), conversion and portoenterostomy were performed. Pre and postoperative data and overall survival rate with the native liver were reviewed.
  
  
  RESULTS
  Forty-four children were treated for BA. Six presented with a cystic form diagnosed by US. Three children had type I BA; three had type III BA. No postoperative complications were noted. Median follow-up was 62.2 months (22.7-93.5). One patient died of a cardiac malformation. The five remaining patients are alive with their native liver. Of the 38 treated for noncystic BA, 16 were transplanted.
  
  
  CONCLUSIONS
  We confirmed the prognosis of cystic BA, which is less severe than noncystic BA. Our strategy using laparoscopy allowed for the confirmation and qualification of the type of BA. In type I, complete treatment by laparoscopy has been performed safely.
authors.affiliation: Department of Paediatric Surgery, Assistance Publique-Hôpitaux de Marseille-La Timone Enfants, Aix-Marseille Université, 13284 Marseille, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Faure
authors.affiliation: Department of Paediatric Surgery, Assistance Publique-Hôpitaux de Marseille-La Timone Enfants, Aix-Marseille Université, 13284 Marseille, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Hery
authors.affiliation: Depatment of Paediatric Radiology, Assistance Publique-Hôpitaux de Marseille-La Timone Enfants, Aix-Marseille Université, 13284 Marseille, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Colavolpe
authors.affiliation: Department of Paediatric Surgery, Assistance Publique-Hôpitaux de Marseille-La Timone Enfants, Aix-Marseille Université, 13284 Marseille, France.
authors.forename: Clemence
authors.initials: C
authors.lastname: Bevilacqua
authors.affiliation: Department of Paediatric Surgery, Assistance Publique-Hôpitaux de Marseille-La Timone Enfants, Aix-Marseille Université, 13284 Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Guys
authors.affiliation: Department of Paediatric Surgery, Assistance Publique-Hôpitaux de Marseille-La Timone Enfants, Aix-Marseille Université, 13284 Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: De Lagausie
keywords: Biliary atresia; children; cystojejunostomy; laparoscopy