Transumbilical single-trocar laparoscopic-assisted cholangiography with a single intraoperative bile duct lavage procedure for inspissated bile syndrome in infants.

BACKGROUND

To evaluate the feasibility, safety, and efficiency of a novel technique for the diagnosis and treatment of inspissated bile syndrome (IBS) in infants: transumbilical single-trocar laparoscopic-assisted cholangiography with a single intraoperative procedure bile duct lavage (TUSLC).

METHODS

This was a prospective cohort study. All infants with IBS admitted to West China Hospital between January 2015 and January 2023 were included in this study. The parents were well informed about the TUSLC procedure and transabdominal three-site laparoscopic-assisted cholangiography with multiple postoperative procedures of bile duct lavage (TATLC) and decided the type of procedure. Fifty milliliters of saline were used to rinse the extrahepatic biliary duct during a TUSLC procedure. The perioperative patient characteristics and short-term follow-up results were compared between the two groups.

RESULTS

In total, 81 children were enrolled. Among them, 33 patients received TUSLC, and 48 patients received TATLC. There were no cases of conversion to open surgery in the TUSLC group, whereas there were 2 cases of conversion in the TATLC group (0.0% vs. 4.2%, P = 0.23). The TUSLC group had shorter operative time (25.1 ± 7.4 vs. 28.0 ± 5.0 min, P = 0.04). The postoperative initial feeding time, and postoperative full enteral feeding achievement time were comparable between the two groups. Compared with the TATLC group, the TUSLC group had a shorter postoperative length of hospital stay (2.4 ± 0.9 vs. 3.7 ± 2.0 days, P = 0.01). The rate of postoperative complications in the TUSLC group was significantly lower than that in the TATLC group (3.0% vs. 20.8%, P = 0.02). During follow-up, the direct bilirubin values among the two groups gradually decreased and were not significantly different.

CONCLUSIONS

TUSLC is a feasible and reliable minimally invasive method for treating IBS and may be an alternative method for the diagnosis and treatment of IBS in infants.