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What is biliary reconstruction?

Biliary reconstruction describes a variety of surgical procedures to replace portions of your child's biliary (bile delivery) system that are missing at birth or damaged due to illness.

Some conditions that could require biliary reconstruction include:

  • infants born without a bile duct (called biliary atresia)
  • a bile duct obstruction such as a choledochal cyst
  • a portion of the liver needs to be removed due to illness

Pioneering treatment

Boston Children's Hospital's Center for Minimally Invasive Surgery is known internationally for having pioneered or perfected many of the minimally invasive surgical procedures in use today. Minimally invasive surgery (MIS) is surgery done through small incisions using miniaturized surgical tools and cameras or telescopes. MIS usually results in less pain, less scarring, and a quicker recovery time for our patients.

One form of MIS used for biliary reconstruction is called laparoscopic surgery, during which surgeons use small instruments guided by a small telescope are passed through the body wall. The instruments are held and manipulated by the surgeon who controls their movements, while watching them on a video screen. This form of MIS has been used widely in adults and more recently in children.

Boston Children's Hospital was the first pediatric hospital to acquire a surgical robot. Today, surgeons use the technology for many procedures and perform more pediatric robotic surgeries on more children than any other hospital in the world.

Our surgeons use robotic surgery to perform biliary reconstructions — it significantly reduces the incision size, pain, length of hospitalization recuperation time, and risk of infection.

Biliary Reconstruction | Frequently Asked Questions


How is biliary reconstruction performed?

There are a variety of surgical procedures to replace portions of your child's biliary system. Some may be done laparoscopically (using a flexible fiberoptic instrument).

What are the advantages of minimally invasive surgical techniques such as laparoscopy?

The advantages of MIS include:

  • It leaves very small scars, which are difficult to see after several months.
  • It means your child will have less pain after surgery.
  • It usually results in a shorter hospital stay. In younger children this advantage is less noticeable because young children recover easier from even major surgery. In school-age and adolescent children, however, the difference is very noticeable. In many cases children can go home in one to two days instead of three to four days. They are able to return to their normal activities more quickly as well. This will depend upon the particular operation, but even after a kidney operation it can be possible to be back to normal activity in seven days instead of two or three weeks.
What are the disadvantages of these surgical techniques?

Surgeons at Boston Children's Hospital use the latest robotic surgery technology to assist with biliary reconstruction procedures.

The technology allows surgeons to use minimally invasive surgical techniques, which reduce the size of the incision required, pain, and the risk of infection — and speed your child’s recovery.

What’s robotic surgery?

Robotic surgery is an exciting and promising area of minimally invasive surgery. Using a high-tech robot, specially trained surgeons perform complex operations through very small surgical openings. What this means for you and your child: less pain, faster recoveries, shorter hospital stays, smaller scars, and wider smiles.

In 2001, Boston Children's Hospital was the first pediatric hospital to acquire a surgical robot. Today, surgeons use the technology for many procedures and perform more pediatric robotic surgeries on more children than any other hospital in the world.

Boston Children's specialists have worked with engineers and medical device manufacturers to develop and refine the robotic equipment specifically for use in children, and they train surgeons from around the world on its use.

Recently, Boston Children’s upgraded to the newest version of the robotic system.

The new robot is much smaller (making it easier to move around, vastly reducing set-up time) and features enhanced high-definition 3-D vision and two consoles so that surgeons can collaborate during a procedure.

What are the benefits of robotic surgery for a biliary reconstruction?

Robotic surgery helps your child recover faster.

The surgical robot’s miniaturized equipment is precise and flexible, and its enhanced imaging provides sharp, clear, 3-D views of the operating site. During robotic surgery, two or three small (½-inch or less) incisions allow a camera and tiny robotic surgical instruments inside the body. Each subtle movement of the surgeon's wrists, hands, and fingers is precisely translated to the tiny surgical instruments inside your child’s body.

This adds up to less pain, smaller incisions, and faster recovery, all things that can bring a smile to your face — and your child’s.

There are relatively few disadvantages to MIS methods, so as long as the surgeon is experienced in using them. More surgeons are being trained in these methods and it is becoming a routine part of training in many centers, like ours.

The overall safety of MIS techniques appears to be equivalent to open surgery in both children and adults. As with all surgery, the experience of the surgeon and the center where it is being performed is very important to the outcome of the operation.

In rare cases, the operation will not be able to be finished laparoscopically, due to unusual anatomy, bleeding, or complications from the procedure. In these cases, the operation will nearly always be finished by traditional methods of "open" surgery, with an incision.

However, there are many some procedures for which MIS is not appropriate for. Technical limitations of MIS equipment — such as lack of dexterity of the tools — make it unsuitable for many certain pediatric procedures.

What is the long-term outlook for a child who requires has biliary reconstruction?

Many children who undergo biliary reconstruction achieve normal digestive function and liver function.

Your child’s physician can give you a more specific prognosis idea of what you can expect.

Biliary Reconstruction | Research & Clinical Trials

Omegaven saves livers

Many children who have complex liver or intestinal surgery can’t eat normally for a long time after. These children are placed on an intravenous method of feeding called parenteral nutrition (PN).

  • PN provides the necessary nutrition for children until their digestive systems adapt and they can eat on their own.
  • PN has revolutionized treatment for certain diseases such as short bowel syndrome. But its prolonged use often damages the liver, potentially leading to liver failure and the need for transplant. And unfortunately, infants are at the greatest risk due to the small size of their livers.

In 2001, surgeon Mark Puder, MD, surgical resident Jenna Garza, MD, and pharmacist Kathy Gura, PharmD, decided to conduct studies in mice to see why PN was causing liver disease. They found evidence that the fat used in standard PN solutions, called Intralipid, was contributing to liver disease by causing fat to accumulate in the liver.

They then tested Omegaven, an IV fat mixture made from fish oil. Fish oil contains omega-3 fatty acids, which have been shown to prevent fat accumulation and have anti-inflammatory properties.

As they hoped, PN using Omegaven as the fat prevented liver injury in the mice.

Surgeon Rusty Jennings, MD, who directs the Boston Children's Maternal Fetal Care Center, had heard of Puder's research and wanted to try Omegaven in one of his patients. Since Omegaven isn't approved for use in the U.S., Puder had to receive special permission from the FDA to use Omegaven rather than Intralipid in his PN solution.

Within eight weeks, the baby's liver function improved so much that he was removed from the liver transplant list.

Puder later treated a second child, a premature baby whose bowel had ruptured; he too had complete resolution of liver disease.

Puder and colleagues are conducting a formal clinical trial and have received funding from the March of Dimes aimed at preventing liver disease in PN recipients. Their work has caused a worldwide shift in treatment. More than 100 children at Boston Children’s have received Omegaven, and over 90 percent of them are still alive.

Biliary Reconstruction | Programs & Services