Laparoscopic Partial Internal Biliary Diversion for Progressive Familial Intrahepatic Cholestasis
Year: 2025
Type: article
Abstract: Intractable pruritus in children is often due to chronic cholestasis syndromes such as progressive familial intrahepatic cholestasis (PFIC) and alagille syndrome. Biliary diversion procedures have been considered for the relief of pruritus in such children with good liver function. The premise of these procedures is to interfere with the enterohepatic circulation, resulting in a reduction of toxic bile salt accumulation. The serum bile acid concentration has been shown to be reduced in patients with successful biliary diversion. We aim to describe the surgical technique of Laparoscopic Partial Internal Biliary Diversion for PFIC. TECHNIQUE The patient was placed in the French position, and the surgery performed using a 10/12 mm infraumbilical optical port and two 5 mm working ports at the right and left lumbar region [Figure 1a and b]. On initial laparoscopy, before proceeding, liver gross appearance along with gallbladder size and distension is visually evaluated to ascertain the feasibility of the procedure [Figure 1c]. Duodenojejunal (DJ) junction identified, and a 15 cm jejunal loop marked 20 cm distal to DJ with different colored sutures for orientation [Figure 1d-f]. Jejunal conduit (JC) isolated extracorporeally through the umbilical port [Figure 2a]. Jejuno-jejunostomy was done extracorporeally in a standard fashion. JC, with the rest of the small bowel, reposited into the abdomen. Proceeding with laparoscopy, JC with care to orientation, was taken to the supracolic compartment through the retrocolic route [Figure 2b-d]. A hitch suture taken over the gallbladder fundus and incised parallel to its axis, and cholecysto-jejunal anastomosis done in a single-layer continuous manner [Figure 2e and f] and jejunocolic anastomosis with transverse colon also done in a similar manner using 4-0 Vicryl/PDS [Figure 2g and h]. Mesenteric windows are closed followed by confirmation of bowel orientation. The success of the surgery will be determined at the 12-month follow-up with regard to the symptom-free period (pruritus, serum bile acid levels).Figure 1: (a) Port position 10 mm infraumbilical optical port and 2 mm × 5 mm working port in the left and right lumbar region, (b) patient position, surgeon stands on the foot end with camera assistant on right of surgeon and scrub nurse on the left, (c) liver gross appearance and gallbladder assessed for the feasibility, (d) proposed jejunal loop of 15 cm identified 20 cm distal to Duodenojejunal, (e and f) proximal and distal orientation sutures placedFigure 2: (a) 15 cm jejunal loop isolated extracorporeally, (b) jejunal loop washed thoroughly, (c) completed Jejuno-jejunostomy, (d) Jejunal conduit taken to supracolic compartment through retro-colic route, (e) Gallbladder and jejunum for the cholecysto-jejunal anastomosis, (f) completed cholecysto-jejunal anastomosis, (g) jejunum and colon for Jejuno-colic anastomosis, (h) completed jejuno-colic anastomosisFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Authors: Nishant Agarwal, Pujana Kanneganti, Anju Verma, Vijai Datta Upadhyay
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4413874836