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Hepatic Portocholecystostomy: 97 Cases From a Single Institution
Géraldine Hery1, Emmanuel Gonzales, Olivier Bernard
1*Department of Pediatric Surgery, Bicetre's Hospital †Department of Pediatric Hepatology, Bicetre's Hospital, Le Kremlin-Bicètre, France.
Journal of Pediatric Gastroenterology and Nutrition
|July 26, 2017
Summary
Hepatoportocholecystostomy (HPC) is effective for biliary atresia cases with patent bile ducts, preventing cholangitis. However, surgeons must monitor for complications like bile leakage and gallbladder obstruction post-surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Biliary atresia affects bile duct drainage.
- 20% of cases lack gallbladder, cystic, and common bile ducts.
- Hepatoportoenterostomy (HPE) is standard, but hepatoportocholecystostomy (HPC) is an alternative.
Purpose of the Study:
- Investigate the efficacy of HPC in biliary atresia.
- Evaluate surgical complications and clinical issues associated with HPC.
- Compare HPC outcomes to HPE in specific patient subsets.
Main Methods:
- Retrospective cohort review of 97 patients undergoing HPC (1984-2009).
- Analysis of postoperative complications including cholangitis, bile leakage, and gallbladder obstruction.
- Assessment of long-term outcomes such as jaundice clearance and need for liver transplantation.
Main Results:
- No bacterial cholangitis in the first 6 months post-HPC.
- 10 patients required conversion to HPE due to bile leakage (9) or gallbladder obstruction (1).
- 5-year follow-up: 46% jaundice-free with native liver, 29.4% transplanted.
Conclusions:
- HPC is a viable surgical option for biliary atresia with patent extrahepatic bile ducts.
- HPC can effectively prevent cholangitis in selected patients.
- Awareness and monitoring of specific postoperative complications are crucial for successful HPC outcomes.
