Pediatric Surgery International

, Volume 34, Issue 4, pp 395–398 | Cite as

Laparoscopic cholangiogram in biliary atresia: a refinement in the gallbladder hitch technique

  • Ravi Kishore
  • Sundeep M. C. Kisku
  • Reju Joseph Thomas
  • Srinivasa Kishore Jeenipalli
Original Article



The study describes a refinement in the gallbladder hitch stitch and assesses the value of the laparoscopic cholangiogram in children with suspected biliary atresia.


Twenty children with neonatal jaundice and no drainage as shown on the HIDA scan underwent a diagnostic laparoscopy through an umbilical 5 mm port. A 3 mm laparoscopic needle holder inserted through a 3.5 mm port to the left of the umbilicus was used to hitch the gallbladder to the abdominal wall. The stylet of a large bore 16F IV cannula then was used to penetrate the gallbladder to perform the laparoscopic cholangiogram.


There was no need for conversion in all 20 children by this technique. Patent biliary anatomy was demonstrated in 11 children (11/20). These children had no further procedures. In 3 (3/20) children, the common bile duct was demonstrated, while the hepatic ducts were not. These children had a laparotomy for Kasai procedure after an open cholangiogram with a vascular bulldog clamp on the CBD confirmed the finding. Six (6/20) had no demonstrable patency; 3 had it confirmed when the abdomen was opened for the Kasai procedure; only those proceeding to Kasai portoenterostomy (3 hepatic duct atresia, 3 complete biliary atresias) had an epidural catheter placed by the anesthetist. The remaining 3 had no further procedure performed due to the advanced nodular liver with ascites and evidence of portal hypertension.


The findings of laparoscopic cholangiogram were confirmed in all six children who underwent laparotomy for Kasai procedure. The laparoscopic cholangiogram using gallbladder hitch reliably demonstrates a patent biliary system (11/11) and was valuable in avoiding further invasive procedures in 70% (14/20) of babies.


Neonatal jaundice Biliary atresia Laparoscopic cholangiogram Gallbladder hitch 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics declaration

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Hirsig J, Rickham PP (1980) Early differential diagnosis of neonatal hepatitis and biliary atresia. J Pediatr Surg 15(1):13–15CrossRefPubMedGoogle Scholar
  2. 2.
    Murat Alkan K, Tutus, Ender, Fakıoglu et al (2016) Laparoscopy assisted percutaneous cholangiography in biliary atresia diagnosis: comparison with open technique. Gastroenterol Res Pract. PubMedGoogle Scholar
  3. 3.
    Tang S-T, Li S-W, Ying Y, Mao Y-Z, Yong W, and Qiang-Song Tong (2009) The evaluation of laparoscopy-assisted cholangiography in the diagnosis of prolonged jaundice in infants. J Laparoendosc Adv Surg Tech 19(6):827–830CrossRefGoogle Scholar
  4. 4.
    Meyers RL, Book LS, O’Gorman MA, White KW, Jaffe RB, Feola PG, Hedlund GL (2004) Percutaneous cholecysto cholangiography in the diagnosis of obstructive jaundice in infants. J Pediatr Surg 39(1):16–18CrossRefPubMedGoogle Scholar
  5. 5.
    Nwomeh BC, Caniano DA, Hogan M (2007) Definitive exclusion of biliary atresia in infants with cholestatic jaundice: the role of percutaneous cholecysto-cholangiography. Pediatr Surg Int 23(9):845–849CrossRefPubMedGoogle Scholar
  6. 6.
    Lee SY, Kim GC, Choe B-H, Ryeom HK, Jang Y-J, Kim HY, Park JY, Cho SM (2011) Efficacy of US-guided percutaneous cholecysto cholangiography for the early exclusion and type determination of biliary atresia. Radiology 261(3):916–922CrossRefPubMedGoogle Scholar
  7. 7.
    Houben CH, Wong HY, Mou WC, Chan KW, Tam YH, Lee KH (2013) Hitching the gallbladder in laparoscopic assisted cholecysto cholangiography: a simple technique. Pediatr Surg Int 29(9):953–955CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Christian Medical College and HospitalVelloreIndia

Personalised recommendations