Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic portoenterostomy versus open portoenterostomy for the treatment of biliary atresia: a systematic review and meta-analysis of comparative studies

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Background

Open portoenterostomy (OPE) remains the mainstay in treatment of biliary atresia, while during the past several years, the laparoscopic portoenterostomy (LPE) has been widely introduced. However, safety of LPE remains a major concern. Thus, we conducted a systematic review and meta-analysis to review the currently available data comparing LPE and OPE.

Design

Systematic review and meta-analysis.

Data sources

Medline, Ovid, Elsevier, Google Scholar Embase, Cohrane library.

Study selection

Comparative cohort studies.

Data extraction

Two investigators independently assessed selected studies and extracted the following information: study characteristics, quality, outcomes data, etc.

Results

Eleven studies about the effectiveness of LPE compared with OPE were performed by meta-analysis. Meta-analysis found no significant difference between the two groups in operative time, hospital stay, intraoperative blood loss, early clearance of jaundice, cholangitis and variceal bleeding. In addition, the rate of 2-year survival with native liver was significantly high in OPE group than in LPE group.

Conclusion

Laparoscopic portoenterostomy could not replace open portoenterostomy and open Kasai portoenterostomy remains the gold standard in the treatment of biliary atresia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Schreiber RA, Kleinman RE (2002) Biliary atresia. J Pediatr Gastroenterol Nutr 35(Suppl 1):S11–S16

    Article  PubMed  Google Scholar 

  2. Puri PHM (2009) Pediatric surgery diagnosis and management. 537–540

  3. Fischler B, Ehrnst A, Forsgren M, Orvell C, Nemeth A (1998) The viral association of neonatal cholestasis in Sweden: a possible link between cytomegalovirus infection and extrahepatic biliary atresia. J Pediatr Gastroenterol Nutr 27:57–64

    Article  CAS  PubMed  Google Scholar 

  4. Chuang JH, Chou MH, Wu CL, Du YY (2006) Implication of innate immunity in the pathogenesis of biliary atresia. Chang Gung Med J 29:240–250

    PubMed  Google Scholar 

  5. Silveira TR, Salzano FM, Donaldson PT, Mieli-Vergani G, Howard ER et al (1993) Association between HLA and extrahepatic biliary atresia. J Pediatr Gastroenterol Nutr 16:114–117

    Article  CAS  PubMed  Google Scholar 

  6. Smith BM, Laberge JM, Schreiber R, Weber AM, Blanchard H (1991) Familial biliary atresia in three siblings including twins. J Pediatr Surg 26:1331–1333

    Article  CAS  PubMed  Google Scholar 

  7. Vijayan V, El TC (2000) Computer-generated three-dimensional morphology of the hepatic hilar bile ducts in biliary atresia. J Pediatr Surg 35:1230–1235

    Article  CAS  PubMed  Google Scholar 

  8. Kasai M, Suzuki S (1959) A new operation for “non-correctable” biliary atresia: hepatic portoenterostomy. Shujjutsu 733

  9. Lykavieris P, Chardot C, Sokhn M, Gauthier F, Valayer J et al (2005) Outcome in adulthood of biliary atresia: a study of 63 patients who survived for over 20 years with their native liver. Hepatology 41:366–371

    Article  PubMed  Google Scholar 

  10. Haafiz AB (2010) Liver fibrosis in biliary atresia. Expert Rev Gastroenterol Hepatol 4:335–343

    Article  PubMed  Google Scholar 

  11. Esteves E, Clemente NE, Ottaiano NM, Devanir JJ, Esteves PR (2002) Laparoscopic Kasai portoenterostomy for biliary atresia. Pediatr Surg Int 18:737–740

    PubMed  Google Scholar 

  12. Martinez-Ferro M, Esteves E, Laje P (2005) Laparoscopic treatment of biliary atresia and choledochal cyst. Semin Pediatr Surg 14:206–215

    Article  PubMed  Google Scholar 

  13. Wada M, Nakamura H, Koga H, Miyano G, Lane GJ et al (2014) Experience of treating biliary atresia with three types of portoenterostomy at a single institution: extended, modified Kasai, and laparoscopic modified Kasai. Pediatr Surg Int 30:863–870

    Article  PubMed  Google Scholar 

  14. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  PubMed Central  PubMed  Google Scholar 

  15. Wells G The Newcastle Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analysis. In: Shea B (ed) Proceedings of the third symposium on systematic reviews. Beyond the basics: improving quality and impact

  16. Clarke M, Horton R (2001) Bringing it all together: lancet-cochrane collaborate on systematic reviews. Lancet 357:1728

    Article  CAS  PubMed  Google Scholar 

  17. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D et al (2000) Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Rev Esp Salud Publ 74:107–118

    CAS  Google Scholar 

  18. Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22:719–748

    CAS  PubMed  Google Scholar 

  19. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  PubMed Central  PubMed  Google Scholar 

  20. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  21. Xu S (2013) Laparoscopic versus open Kasai portoenterostomy in infants with type III biliary atresia: a prospective study. In: Long L (ed). pp 22–25

  22. Ure BM, Kuebler JF, Schukfeh N, Engelmann C, Dingemann J et al (2011) Survival with the native liver after laparoscopic versus conventional kasai portoenterostomy in infants with biliary atresia: a prospective trial. Ann Surg 253:826–830

    Article  PubMed  Google Scholar 

  23. Nakamura H, Koga H, Okazaki T, Urao M, Miyano G, et al. (2014) Does pneumoperitoneum adversely affect growth, development and liver function in biliary atresia patients after laparoscopic portoenterostomy? Pediatr Surg Int

  24. Chan KWE, Lee KH, Wong HYV, Tsui SYB, Wong YS et al (2014) From laparoscopic to open Kasai portoenterostomy: the outcome after reintroduction of open Kasai portoenterostomy in infant with biliary atresia. Pediatr Surg Int 30:605–608

    Article  PubMed  Google Scholar 

  25. Diao M, Li L, Cheng W (2013) Single-incision laparoscopic hepaticojejunostomy using conventional instruments for neonates with extrahepatic biliary cystic lesions. Surg Innov 20:214–218

    Article  PubMed  Google Scholar 

  26. Chan KW, Lee KH, Tsui SY, Wong YS, Pang KY et al (2012) Laparoscopic versus open Kasai portoenterostomy in infant with biliary atresia: a retrospective review on the 5-year native liver survival. Pediatr Surg Int 28:1109–1113

    Article  PubMed  Google Scholar 

  27. Oetzmann VSC, Petersen C, Ure BM, Osthaus A, Schubert KP et al (2012) Laparoscopic versus conventional Kasai portoenterostomy does not facilitate subsequent liver transplantation in infants with biliary atresia. J Laparoendosc Adv Surg Tech A 22:408–411

    Article  Google Scholar 

  28. Wen Ying H, Long L, Shuli L, Jun Z, Liuming H, et al. (2008) Comparison of laparoscopic and open portoenterostomy for type III biliary atresia. Chin J Min Inv Surg 8:769–771

  29. Aspelund G, Ling SC, Ng V, Kim PC (2007) A role for laparoscopic approach in the treatment of biliary atresia and choledochal cysts. J Pediatr Surg 42:869–872

    Article  PubMed  Google Scholar 

  30. Xuelai L, Long L, Jun Z, Wenying H, Liuming H (2006) A comparison study of laparoscopic versus open Kasai portoenterostomy for pediatrics biliary atresia. Chin J Minim Invasive Surg 6:761–763

    Google Scholar 

  31. Gan P (2014) A novel liver retractor for reduced or single-port laparoscopic surgery. Surg Endosc 28:331–335

    Article  PubMed  Google Scholar 

  32. Wang B, Feng Q, Ye X, Zeng S (2014) The experience and technique in laparoscopic portoenterostomy for biliary atresia. J Laparoendosc Adv Surg Tech A 24:350–353

    Article  PubMed  Google Scholar 

  33. Laje P, Clark FH, Friedman JR, Flake AW (2010) Increased susceptibility to liver damage from pneumoperitoneum in a murine model of biliary atresia. J Pediatr Surg 45:1791–1796

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank those authors who provided us with the full text and the relevant data from their studies.

Conflict of interest

None declared.

Author information

Author notes

    Authors and Affiliations

    1. Department of Pediatric Surgery, Capital Institute of Pediatrics, Teaching hospital of Peking University, Yabao Road2#, Chaoyang, Beijing, 100021, People’s Republic of China

      Ma Lishuang, Chen Zhen, Qiao Guoliang, Zhang Zhen, Wang Chen, Li Long & Liu Shuli

    2. Medical Department, Peking University, Beijing, 100000, People’s Republic of China

      Chen Zhen

    Authors
    1. Ma Lishuang
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Chen Zhen
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Qiao Guoliang
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Zhang Zhen
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Wang Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Li Long
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Liu Shuli
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding authors

    Correspondence to Li Long or Liu Shuli.

    Additional information

    M. Lishuang and C. Zhen contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Lishuang, M., Zhen, C., Guoliang, Q. et al. Laparoscopic portoenterostomy versus open portoenterostomy for the treatment of biliary atresia: a systematic review and meta-analysis of comparative studies. Pediatr Surg Int 31, 261–269 (2015). https://doi.org/10.1007/s00383-015-3662-7

    Download citation

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00383-015-3662-7

    Keywords

    Search

    Navigation