Outcome of partial internal biliary diversion for intractable pruritus in children with cholestatic liver disease

P. Ramachandran*, N. P. Shanmugam, S. Al Sinani, V. Shanmugam, S. Srinivas, M. Sathiyasekaran, V. Tamilvanan, M. Rela

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)


Purpose: Children with cholestatic disorders have undergone liver transplantation for intractable pruritus unresponsive to medical therapy even in the absence of liver failure. Biliary diversion procedures interrupt the entero-hepatic circulation of bile acids allowing them to be excreted in the feces thereby lowering the total bile acid pool. We evaluated the outcome of partial internal biliary diversion (PIBD) in children with intractable pruritus from inherited cholestatic disorders.Methods: The records of children who underwent PIBD over a 4-year period were reviewed for etiology of liver disease, demographic data, preoperative and postoperative biochemical profile and improvement of pruritus. Standard statistical methods were used for analysis.Results: Of the 12 children, 10 had progressive familial intrahepatic cholestasis (PFIC) and 2 had Alagille syndrome (AS). PIBD was done using an isolated jejunal loop as a conduit from gall bladder to mid ascending colon. Median period of follow up was 30 months. Pruritus resolved in nine children with significant reduction of serum bile acids (P < 0.02).Conclusion: To our knowledge, this is the largest reported series of children with PIBD. PIBD is a safe, well-tolerated and effective alternative to liver transplant in children with PFIC and AS who have intractable pruritus in the absence of synthetic liver failure.

Original languageEnglish
Pages (from-to)1045-1049
Number of pages5
JournalPediatric Surgery International
Issue number10
Publication statusPublished - Oct 2014


  • Alagille syndrome
  • Partial internal biliary diversion
  • Persistent familial intrahepatic cholestasis
  • Pruritus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


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