Laparoscopic partial external biliary diversion procedure in progressive familial intrahepatic cholestasis

Abstract

The laparoscopic partial biliary diversion procedure is feasible with all the benefits of minimally invasive surgery. Long-term results remain to be evaluated.

Modified laparoscopic external biliary diversion for benign recurrent intrahepatic cholestasis in obese adolescents

“…We recently introduced a new laparoscopic technique of partial external biliary diversion and achieved excellent results in four children with PFIC [6]. However, we experienced difficulties in the exteriorisation of a jejunal loop via the infraumbilical trocar site, in particular, in obese patients.…”

“…Benign recurrent intrahepatic cholestasis is characterised by episodic cholestasis and pruritus without obstruction, which commence during early childhood [2,6,7]. Laboratory investigations show an episodic increase of serum bilirubin and bile acids, but normal gamma-glutamyl transpeptidase (GGT) levels.…”

“…Laparoscopic techniques have evolved as standard procedures for various cholestatic diseases in children and adolescents [6,13,14]. We recently introduced a new laparoscopic technique of partial external biliary diversion and achieved excellent results in four children with PFIC [6].…”

“…Recently, we introduced a new laparoscopic technique of partial external biliary diversion for infants with PFIC [6]. However, the described technique requires bowel exteriorisation for creation of a bowel conduit and minimal umbilical incision may hinder adequate mobilisation, in particular, in obese adolescents.…”

Liver disease associated with canalicular transport defects: Current and future therapies

“…This innovative technique was quickly adopted by other centres worldwide and so far sixteen additional casereports/series addressing the effect and technique of PEBD in the treatment of PFIC have been published (Table 3). Except for one small series of five patients in which PEBD did not have any effect [104], all others report normalization or improvement of liver function in 75-100% of the patients with low GGT-PFIC, indicated by at least improved liver tests and reduced pruritus [106,108,110,112,[136][137][138][139][140][141][142][143]. The response in patients with an undefined subtype of PFIC seems to be less [111,144].…”