Eur J Pediatr Surg 2021; 31(04): 341-346
DOI: 10.1055/s-0040-1714657
Original Article

Partial Biliary Diversion May Promote Long-Term Relief of Pruritus and Native Liver Survival in Children with Cholestatic Liver Diseases

Kristin Bjørnland
1   Section of Pediatric Surgery, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
Maria Hukkinen
2   Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
Vladimir Gatzinsky
3   Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden
Henrik Arnell
4   Department of Pediatrics, Astrid Lindgren Children's Hospital, Stockholm, Sweden
Mikko P. Pakarinen
2   Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
Runar Almaas
5   Department of Pediatrics, Oslo universitetssykehus, Rikshospitalet, University of Oslo, Oslo, Norway
Jan F. Svensson
6   Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
› Author Affiliations


Introduction Rare cholestatic liver diseases may cause debilitating pruritus in children. Partial biliary diversion (PBD) may relieve pruritus and postpone liver transplantation which is the only other alternative when conservative treatment fails. The aim was to report long-term outcome after PBD in a population of 26 million people during a 25-year period.

Materials and Methods This is an international, multicenter retrospective study reviewing medical journals. Complications were graded according to the Clavien–Dindo classification system.

Results Thirty-three patients, 14 males, underwent PBD at a median of 1.5 (0.3–13) years at four Nordic pediatric surgical centers. Progressive familial intrahepatic cholestasis was the most common underlying condition. Initially, all patients got external diversion, either cholecystojejunostomy (25 patients) or button placed in the gallbladder or a jejunal conduit. Early complications occurred in 14 (42%) patients, of which 3 were Clavien–Dindo grade 3. Long-term stoma-related complications were common (55%). Twenty secondary surgeries were performed due to stoma problems such as prolapse, stricture, and bleeding, or conversion to another form of PBD. Thirteen children have undergone liver transplantation, and two are listed for transplantation due to inefficient effect of PBD on pruritus. Serum levels of bile acids in the first week after PBD construction were significantly lower in patients with good relief of pruritus than in those with poor effect (13 [2–192] vs. 148 [5–383] μmol/L; p = 0.02).

Conclusion PBD may ensure long-term satisfactory effect on intolerable pruritus and native liver survival in children with cholestatic liver disease. However, stoma-related problems and reoperations are common.

Publication History

Received: 26 March 2020

Accepted: 18 June 2020

Publication Date:
24 July 2020 (online)

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