The most common disorders of delayed jaundice in newborns and infants are infantile hepatitis syndrome (HIS) or cholestatic syndrome (CS), biliary atresia (BA), or biliary dysplasia ( congenitalbile duct hypoplasia (CBDH). Early clinical manifestations and blood biochemical tests overlap, and children with BA have better surgical outcomes within 60 days, but it is precisely within 60 days that differentiation from other diseases is extremely difficult. Therefore, early diagnosis of BA is very important. Due to the poor development and imperfect function of the liver and bile ducts in newborns, the images of B-mode ultrasound, hepatobiliary nuclide dynamic examination, MRCP, ERCP and other auxiliary examinations are blurred or difficult to operate, so it is often too late to reach a correct diagnosis and open abdominal investigation is needed. However, traditional open cholangiography is very invasive and not suitable for children with HIS and CS. Laparoscopic cholangiography is an ideal test that is less invasive and can reveal the entire biliary tree structure and morphology. This article discusses the value and technique of diagnostic laparoscopic cholangiography in young infants with delayed jaundice disease. In the last year, 38 children with delayed jaundice were admitted to our department, 15 males and 23 females. The average age was 74 d ( 27 d to 140 d). All of them presented with yellow skin staining with progressive worsening, white clay-colored stools and dark tea-colored urine. Physical examination: The skin and sclera showed moderate to severe yellow staining, and the liver was enlarged to varying degrees, with a hard texture and blunt edges. Liver function tests: total bilirubin, direct bilirubin, indirect bilirubin, glutamic oxalacetic aminotransferase and glutamic alanine aminotransferase were all significantly higher than normal. Routine diagnostic examinations (physical examination, blood biochemistry, B-mode ultrasound, hepatobiliary nuclide dynamic examination, MRCP, etc.) could not confirm the diagnosis, and it was especially necessary to exclude BA, and laparoscopy-assisted cholangiography was routinely performed before performing caesarean or Kasai surgery. The results showed that all 38 cases were clearly diagnosed by laparoscopic cholangiography with minimal intraoperative bleeding and no surgical complications. 12 children had normal-sized gallbladders with brownish or yellowish-green livers, and the cholangiography showed a patent biliary tree in 8 cases with infantile hepatitis syndrome or cholestasis with simultaneous biliary flushing and indwelling cystic flushing tubes; 2 cases showed bile duct dysplasia; 2 cases had open cystic ducts and common bile ducts. However, the right and left hepatic ducts and intrahepatic bile ducts were atretic. In the other 3 cases, the catheter could be placed into the gallbladder, but the intrahepatic and extrahepatic bile ducts were not visualized after contrast injection, suggesting biliary atresia, and all of them underwent Kasai surgery. In the remaining 21 children, the gallbladder was striated, the lumen of the gallbladder was occluded, the liver was hard and dark green in color, the abdomen was opened in the middle, and the gallbladder was not seen by incision or there was a potential lumen, and the catheter could not be placed into the gallbladder, so cholangiography was abandoned and Kasai surgery was performed. The most important distinction to make in delayed jaundice in infants and children is between HIS (including CS) and BA (including CBDH), with approximately 20% of HIS developing complete obstruction of the bile duct early in the disease (CS). The symptoms of both are similar, but the treatment and outcome are very different. China is a country with a high prevalence of biliary atresia, and because of the difficulty of early diagnosis and late diagnosis, most children do not undergo a caesarean section until they have significant cirrhosis. Some scholars have suggested that all children with obstructive jaundice should undergo open abdominal exploration and intraoperative cholangiography to enable early surgical treatment of biliary atresia. However, some scholars oppose the idea that laparoscopic exploration is harmful in children who do not have biliary atresia, such as infantile hepatitis syndrome, and that it should be delayed until at least 4 months of age. Laparoscopic cholangiography can help in the early diagnosis of biliary atresia while avoiding excessive injury in children with infantile hepatitis syndrome. There are three methods of laparoscopic-assisted cholangiography reported in the literature: first, cholangiography with direct visualization of the gallbladder after laparoscopic exploration; second, cholangiography with intubation into the gallbladder via the hepatic route under laparoscopic surveillance; and third, cholangiography with perforation of the gallbladder through the abdominal wall under laparoscopic surveillance. In our experience, it is very difficult to implant a catheter into an atretic gallbladder even in an open situation. In the present group of 21 children, laparoscopy showed a striped occlusion of the gallbladder, and no or only a potential lumen was seen after open incision of the gallbladder, and some of them had a little white or yellow mucus, and the catheter could not be inserted into the gallbladder. Therefore, cholangiography via the hepatic route in children with biliary atresia is very difficult and increases the risk of bleeding and biliary fistula. Laparoscopic cholangiography via abdominal wall gallbladder puncture is also not an easy and time consuming task if the gallbladder is atretic. If the gallbladder is patent and the puncture is successful, post-imaging tube placement (postoperative biliary flushing) and fixation are also more problematic. Laparoscopic cholangiography in adults is a more mature endoscopic technique, and is routinely performed after cholecystectomy via the cystic duct. The cholangiography technique in infants and children is different from that in adults, because the bile ducts of infants and children are slender, and intra-abdominal intubation through the gallbladder is difficult. At the same time, the abdominal wall of infants and young children is thin, so the gallbladder can be raised outside the abdominal wall under direct laparoscopic view from the subcostal margin of the trocar, and the placement of ductography is simple and easy, and can be successful. Our technique is to apply the magnification principle of laparoscopy to carefully examine the size of the gallbladder, the degree of liver fibrosis and the color of the liver, to determine whether the gallbladder needs to be simply freed, to drag the bottom of the gallbladder through a 5-mm hole under the right costal margin to the outside of the abdominal cavity, to incise the gallbladder under direct vision, and to insert the duct into the gallbladder. The whole procedure is simple and almost bloodless. And the risk of biliary fistula and gallbladder perforation is avoided. In our group of 12 children, the size of the gallbladder was normal under lumpectomy, and all of them were successfully dragged out of the gallbladder and contrasted successfully. In some children with dysplastic gallbladder and small size, it is not easy to lift the gallbladder out of the abdominal wall directly from the trocar, so the gallbladder tract can be freed under laparoscopy to preserve the artery of the gallbladder, and then the bottom of the gallbladder can be dragged out of the abdominal cavity for intubation and imaging. Note that while dragging out the gallbladder, the pneumoperitoneum should be released and the abdominal wall should be pressed downward, and the ascites should be aspirated before dragging out. The indications for this method are newborns or infants with delayed jaundice, and contraindications are cardiopulmonary insufficiency and advanced cirrhotic coagulation disorders. In children with intraoperative contrast diagnosis of infantile hepatitis syndrome or cholestasis, the bile duct can be flushed intraoperatively and postoperative flushing of the bile duct can be performed with an indwelling fistula from the subcostal trocar. Cholestasis is one of the causes of obstructive jaundice in infants and children, mostly due to viral and metabolic abnormalities. Biliary irrigation alone can often cure most children, and laparoscopic surgery is superior in this group of patients. In our group, 8 children with cholestasis avoided open trauma, and the jaundice disappeared after six months of follow-up. 4 children with biliary dysplasia diagnosed by imaging showed bile duct patency, and in 2 cases, the internal diameter of common bile duct was 2.5mm and 2.8mm, respectively, and simple biliary flushing was performed, and the jaundice disappeared after 6 and 8 months of follow-up. 26 children were diagnosed with BA by imaging, and in 2 cases, the development of gallbladder was basically normal, and the contrast agent could enter the duodenum smoothly but could not enter the duodenum. The diagnosis of intrahepatic BA was made in two cases, in which the contrast agent could enter the duodenum smoothly but not the intrahepatic bile duct. 3 cases had dysplasia of the gallbladder and the catheter could enter the gallbladder, but the imaging failed to show the intra- and extrahepatic bile ducts. 21 cases had a striped gallbladder and atresia of the gallbladder lumen, and the intubation imaging failed, and the diagnosis of extra- or intrahepatic BA was made. There are many methods to identify delayed jaundice in newborns and infants, and the confirmation rate is mostly in the range of 40% to 87%, and cholangiography is considered to be the most ideal method for definitive diagnosis at present. Traditional open cholangiography is very invasive and is not suitable for all children with jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) is limited in the diagnosis of infants and children because of the equipment and technique. Therefore, we believe that laparoscopic cholangiopancreatography is the “gold standard” method for the early diagnosis of delayed jaundice in newborns and infants. This method is simple, safe, minimally invasive, and clearly diagnostic. Laparoscopic observation of the gallbladder is also of practical value, as children with BA are excluded from having a normal-sized gallbladder, while children with atresia can be diagnosed with BA and require Kasai surgery. Our experience is that in newborns or infants with delayed jaundice, after first 2 weeks of conservative treatment for neonatal hepatitis, no improvement in clinical symptoms and worsening jaundice should be an indication for laparoscopic cholangiopancreatography. Early laparoscopy can quickly distinguish between surgical and non-surgical cases, and the appropriate targeted treatment can be made.