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Does pneumoperitoneum adversely affect growth, development and liver function in biliary atresia patients after laparoscopic portoenterostomy?

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Abstract

Purpose

We assessed the effect of high partial pressure of arterial carbon dioxide (PaCO2) due to pneumoperitoneum (PP) on growth (height/weight) and development (gross/fine motor function, receptive/expressive communication, and social interaction), by comparing outcome after portoenterostomy (PE) for biliary atresia (BA) using laparoscopic PE (LPE: n = 13) and open PE (OPE: n = 13) cases performed between 2005 and 2014.

Methods

Our PE is based on Kasai’s original PE. All data were collated prospectively.

Results

Differences in duration of follow-up (LPE: 38.8 months; OPE: 38.1 months), jaundice clearance (LPE: 12/13 = 92.3 %; OPE: 9/13 = 69.2 %), survival with the native liver (LPE: 10/13 = 76.9 %; OPE: 9/13 = 69.2 %), incidence of cholangitis, hypersplenism, and incidence of esophageal varices were not significant. Mean intraoperative PaCO2 was significantly higher in LPE (LPE: 50.1 mmHg; OPE: 40.7 mmHg, p < 0.05). Liver function impairment was not statistically different, although LPE results were slightly worse. There was no overall delay in growth observed, although height/weight gain was more consistent in LPE. The pattern of developmental delay observed was similar for LPE and OPE suggesting that developmental delay is not PE-related; in other words, PP is not implicated in developmental delay.

Conclusions

PP during LPE would appear to have no adverse effects on overall growth/development and liver function in BA patients.

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Authors and Affiliations

  1. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Hiroki Nakamura, Hiroyuki Koga, Go Miyano, Manabu Okawada, Takashi Doi, Geoffrey J. Lane & Atsuyuki Yamataka

  2. Department of Pediatric Surgery, Juntendo University Nerima Hospital, Tokyo, Japan

    Masahiko Urao & Hiroko Watayo

  3. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan

    Tadaharu Okazaki & Yuki Ogasawara

Authors
  1. Hiroki Nakamura
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  2. Hiroyuki Koga
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  3. Tadaharu Okazaki
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  4. Masahiko Urao
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  5. Go Miyano
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  6. Manabu Okawada
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  7. Takashi Doi
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  8. Hiroko Watayo
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  9. Yuki Ogasawara
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  10. Geoffrey J. Lane
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  11. Atsuyuki Yamataka
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Correspondence to Atsuyuki Yamataka.

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Nakamura, H., Koga, H., Okazaki, T. et al. Does pneumoperitoneum adversely affect growth, development and liver function in biliary atresia patients after laparoscopic portoenterostomy?. Pediatr Surg Int 31, 45–51 (2015). https://doi.org/10.1007/s00383-014-3625-4

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  • DOI: https://doi.org/10.1007/s00383-014-3625-4

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