Laparoscopic partial internal biliary diversion through a cholecystojejunocolonic anastomosis in children: Report of a case series with a novel simplified approach

Abstract

Background: Biliary diversion techniques have been described as an alternative for the treatment of intractable pruritus due to chronic cholestasis. The aim of this study was to describe a simplified partial internal biliary diversion by laparoscopy and to evaluate the results in these patients. Methods: Between 2017 and 2021, three children with chronic cholestasis disease underwent Laparoscopic partial internal biliary diversion (Lapin-PIBD). The etiologies were: Alagille Syndrome, Arthrogryposis-Renal dysfunction-Cholestasis and cholestatic liver disease associated with KMT2D mutation. Laparoscopic procedure included: mobilization of the ascending colon, jejunal bowel exteriorization through the umbilical incision and creation of an isoperistaltic jejunal segment. Jejuno-jejunal anastomosis and jejuno-colonic anastomosis were performed extracorporeally. Proximal jejunum was anastomosed to the fundus of the gallbladder using intracorporeal interrupted sutures. In one case Indocyanine green (ICG) fluorescence was used to evaluate the passage of the bile through the conduit and the bowel vascularization. Results: Three patients underwent Lapin-PIBD successfully. The median weight was 10.8 kg (5.6–16). All patients showed reduction of pruritus and liver enzymes levels at three months postoperatively. Mean follow-up was 28 months and none of the children had complications. Conclusions: Lapin-BD through cholecystojejunocolonic anastomosis is an effective treatment of severe pruritus in patients with chronic cholestasis improving their quality of life. It offers the advantages of minimally invasive surgery and reduces the abdominal adhesions in patients who may require a liver transplant in the future.Level of Evidence:IV

Keywords

• Pruritus
• Cholestasis
• Biliary diversion
• Partial internal biliary diversion
• Laparoscopy
• Children