Patrick Chung,Paul Tam.Twelfth issue 2019, guide of article reading in Journal of Pediatric Surgery[J].Journal of Clinical Pediatric Surgery,,19():2-2.
Twelfth issue 2019, guide of article reading in Journal of Pediatric Surgery
Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R]
volume:
第19卷
Number:
2020 02
Page:
2-2
Column:
专家笔谈
Date of publication:
2020-02-20
- Document code:
- A
- Abstract:
-
It gives me much pleasure to write a review article for the papers published in this issue (Dec 2019) of the JPS. In this current issue, as usual, there are several high-quality studies published on the topics of thoracic, gastrointestinal, hepatobiliary and urology conditions. A variety of studies have been included and some of which are prospective randomized study or meta-analysis that provide the highest level of evidence. Apart from clinical studies, a few paper focused on translational research works which have the potential to advance our knowledge in the clinical management paediatric cancer and several intestinal diseases. Among all these studies, there are two paper (1, 2) from Japan that I would like to recommend for reading. They are entitled ‘The outcome of real-time evaluation of biliary flow using near-infrared fluorescence cholangiography with Indocyanine green in biliary atresia surgery’ Both studies addressed on biliary atresia. One (1) of them questioned the traditional wisdom of performing liver biopsy on suspected biliary atresia while another paper proposed a novel technology to assist the level of porta transection during the Kasai operation Indocyanide Green technology. Both issues are linked to the survival and prognosis of biliary atresia patients and are therefore highly relevant to our clinical practice.
Ultrasound image and liver biopsy have been widely accepted as part of the diagnostic protocol for anyone with cholestasis and suspected biliary atresia. In an ideal situation, when the ultrasound examination shows a distended gallbladder and liver histology is unremarkable, patients could be excluded from having biliary atresia. This would help to avoid unnecessary laparotomy which is a major trauma to a young infant. However, not uncommonly, the findings from ultrasound and liver biopsy are equivocal and the baby still need to undergo a major laparotomy which may turn out to be negative. In the era of laparoscopy, the authors of this paper questioned this practice and evaluated the value of liver biopsy. In their paper, the diagnostic accuracy of laparoscopy was 100% and patients received immediate Kasai operation. In my opinion, this paper has pointed out an important change brought about by laparoscopy since the 21 st century, that is --- direct access to organs with minimal surgical trauma only. Although the risk of liver biopsy resulted in life-threatening event is low, major bleeding could still happen from time to time and in this regard, the risk of bleeding maybe even lower in laparoscopy. In addition, with the advances in paediatric anesthesia, the anesthetic risk of laparoscopy is comparable to the sedation risk of performing liver biopsy. And another major advantage of performing laparoscopy directly is the shortening of the waiting time. Nonetheless, I believe that liver biopsy under the same session of laparoscopy is still warranted as a mean to assess the underlying liver damage in biliary atresia cases (before proceeding to Kasai operation) or for making the diagnosis in case biliary atresia is excluded after laparoscopic assessment.
Last Update:
2020-02-21