Table 1: Causes of Neonatal Jaundice

INFECTIOUS

Viral

Cytomegalovirus	Reovirus Type 3
Rubella	Coxsackie B
Hepatitis	HIV
Herpes	Echovirus

Bacterial

Gram Negative	Syphilis
Toxoplasmosis	Tuberculosis

STRUCTURAL

Biliary Atresia

Spontaneous Perforation of bile ducts

Choledochal Cyst

Cholelithiasis

Bile ducts Strictures

METABOLIC

Alpha-1-antitrypsin deficiency	Alagille's syndrome
Galactosemia	Hypopituitarism
Fructosemia	Polysplenic syndrome
Tyrosinemia	TPN
Glycogenosis	Cystic Fibrosis
Gaucher's disease	Congenital Hepatic Fibrosis
Niemann-Pick	Byler's disease
Hypothyroidism	Turner Syndrome

SYSTEMIC

Post NEC	Congenital Heart Failure
Left hypoplastic heart syndrome	Sepsis
Shock/Hypoperfusion	Drug Induced

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Table 2: Postoperative Complications

Cholangitis
Sudden Cease of Bile Flow
Portal Hypertension
	Esophageal Varices
	Hypersplenism
	Ascites
Essential Fatty Acid deficiency
Vitamisn Malabsorbtion (A,D,K,E)
Essential Metals deficiency
Pruritus

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Table 3: Prognostic Factors Associated to Kasai Procedure

Preoperative Factors
	age at surgery
	hepatic histology
	race
Operative Factors
	morphologic type
	size ductular structures at porta hepatis
	surgical technique
	type of surgical reconstruction
Postoperative Factors
	bile flow
	cholangitis
	portal hypertension

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Table 4: Results After Kasai Procedure

Series	Year	# Pts.	5-yr Survival	10-yr Survival	20-yr Survival
Carcassone et al(50)	1977	532	12.7%	-	-
Akiyama et al(51)	1978	90	41.1%	-	-
Kobayashi (52)	1984	135	29%	-	-
Tohoku University Hospital (13)	1953-1991	274	35%	33.5%*	-
Altman (30)	1974-1986	225	59.5%	33%	-
National Biliary Atresia Registry (20)	1976-1989	670	48%	35%**	-
Toyosake et al (49)		76	-	27.6%	7.8%

* of 194 patients who initially survived** approximation of the graphic of survival

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Figure 1: Morphologic Types of Biliary Atresia

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Table 1: AGE AT OPERATION

No in ( ) are %
	MALES	FEMALES	TOTAL
0-2 mo.	16	10	26 (16)
2-12 mo.	31	22	53 (33)
12-24 mo.	15	3	18 (11)
2-5 y/o	21	20	41 (26)
> 6 y/o	6	17	23 (14)
TOTAL		72	161 (100)

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Table 2: MODE OF PRESENTATION

	MALES	FEMALES	TOTAL
RIH	37	32	69 (43)
LIH	29	18	47 (29)
BIH	23	22	45 (28)
TOTAL	89	72	161 (100)

No. in ( ) are %, RIH= right inguinal hernia, LIH= left inguinal hernia, BIH= bilateral inguinal hernia

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Table 3: ASSOCIATED CONDITIONS

Respiratory illness (i.e. asthma)	40 (25)
Congenital Heart Disease (VSD, PDA)	6 (4)
GU
Hydrocele	23 (14)
Cryptorchidism	3 (2)
Hypospadia	1 (0.6)
Retractile testis	1 (0.6)
Polycystic Kidneys	1 (0.6)
Umbilical Hernia	10 (6)
Neurological
V-P Shunt	1 (0.6)

No in ( ) are %

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Table 4: CONTRALATERAL FINDINGS

INITIAL DIAGNOSIS	HS	PPV	OPV
RIH 69 pts.	28 (41)	23 (33)	18 (26)
LIH 47 pts.	19 (40)	13 (28)	15 (32)
TOTAL 116 pts.	47 (41)	36 (31)	33 (28)

No in ( ) are %, RIH= right inguinal hernia, LIH= left inguinal hernia, BIH= bilateral inguinal hernia

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Table 5: POSTOP COMPLICATIONS

No in ( ) are %
Residual hydrocele	2 (1.2)
Post-op Apnea	1 (0.6)
Post-intubation Croup	1 (0.6)
Testicular edema/atrophy	0
Recurrence	0

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Table 6: SUBGROUP OF PATIENTS AND CONTRALATERAL FINDINGS

	CASES	+ FINDINGS	- FINDINGS	PROBABILITY
		(HS + PPV)	(OPV)
SEX
Males	66	37	29	NSS
Females	50	46	4	p < 0.0001
GESTATIONAL AGE
Term	63	44	19	NSS
Prematures	14	9	5	NSS
AGE AT OPERATION
0-2 mo	16	15	1	p < 0.0005
2-12 mo	42	25	17	NSS
12-24 mo	17	7	10	NSS
2-5 y/o	28	24	4	p < 0.01
> 6 y/o	13	12	1	p < 0.005

HS= hernial sac, PPV= patent procesus vaginalis, OPV= obliterated procesus vaginalis, NSS= not statistically significant.

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Figure #1:

Computerized Abdominal Tomography view showing a large intragastric solid mass

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Figure #2:

Upper contrast gastrointestinal study using barium demonstrating the intragastric bezoar with the characteristic honey-comb pattern

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Figure #3:

Gastroduodenal bezoar assuming the shape of the stomach and proximal duodenum

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Graph 1: Intra-Abdominal Pressure (IAP*) as a measure of Body Weight in kilograms (Kg)

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Table 1: Indications for Diagnostic and Therapeutic Laparoscopy

Diagnostic Abdominal Laparoscopy

Liver Biopsy Direct

Cholangiography

Splenic Biopsy

Lower GI Bleeding

Non-palpable Undescended Testis

Intersexual Anomalies

Recurrent Abdominal Pain

Blunt/Sharp Abdominal Trauma

Seromuscular Bowel Biopsy

Tumor Staging

Gynecologic Tumors

Groin Laparoscopy

Therapeutic Abdominal Laparoscopy

Cholecystectomy

Anti-reflux surgery

Appendectomy

Gastric Surgery

Pyloromyotomy

Small Bowel Resection

Colon Pull-through Nephrectomy

Adrenalectomy

Varicocelectomy

Stephen-Fowlers technique

Resection Ovarian tumors

Lysis of adhesions

V-P shunt placement

Gonadectomy

Uncomplicated Liver cysts

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Table 2: UPH Experience: Comparison between LC and OC

	OC (16)	LC (24)	probability
Age (years)	7.9	11.9	0.01 *
Hx prior surgery	5	1	0.04 *
Cholangiogram	7	1	0.006 *
Prophylactic Antibiotics	17	16	0.01 *
OR time (min)	114	84	0.04 *
Postoperative Complications	7	4	0.1
Diet Resumption (days)	1.8	0.6	0.0004 *
Pain medication (days)	1.8	0.3	0.00009 *
Hospital stay (days)	7.2	3.1	0.003 *

* p < 0.05

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Table 3: San Pablo Experience: Comparison between LC and OC

	LC (59)	OC (24)	probability
Age (years)	15.1	13.8	NSS
Sex (F:M)	49:10	14:10	0.02 *
Obesity	11	3	NSS
Emergency	13	11	0.03 *
Abnormal Liver Chemistry	12	8	NSS
Associated Illness	27	8	NSS
Post-surgical stay (days)	1.5	3.3	0.0004 *
Cholangiogram	12	14	0.007 *
OR time (min)	94	138	0.03 *
Surgical time (min)	53	98	0.003 *
Hospital stay (days)	2.3	4.6	0.000001 *
Complications	12	10	NSS
Diet (days)	0.8	1.5	0.00000 *
Pain medication (days)	0.7	1.4	0.00000 *

* p < 0.05 ; NSS = not statistically significant