Which surgical procedures are performed in the workup of cholestasis?

Updated: Aug 09, 2017
  • Author: Hisham Nazer, MBBCh, FRCP, DTM&H; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Liver biopsy is the single most useful test to determine the cause of cholestasis but requires a high degree of expertise in interpretation.

Exploratory surgery is a very useful tool for diagnosing neonatal cholestasis. Older literature suggested that exploratory surgery placed patients with neonatal hepatitis at risk, but this is not the case with modern anesthesia and surgical techniques. If surgical disease is in question, initiate exploratory surgery to provide a definitive demonstration of bile duct anatomy. In institutions with less experience and expertise, perform exploratory surgery more frequently, rather than less so.

Operative cholangiography is simple, straightforward, time-efficient, and definitive.


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