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Should open Kasai portoenterostomy be performed for biliary atresia in the era of laparoscopy?

  • Kenneth K. Y. Wong
  • Patrick H. Y. Chung
  • Kwong-leung Chan
  • Sheung-tat Fan
  • Paul K. H. Tam
Original Article

Abstract

Kasai portoenterostomy has been the treatment of choice for neonates with biliary atresia since its introduction. With the advance in laparoscopic techniques, a few centers have reported the feasibility of performing laparoscopic Kasai portoenterostomy. However, the outcome of this new technique is not known. Here, we aim to evaluate, as the only referral center for liver transplantation, our experience with patients referred for transplantation after failed Kasai portoenterostomy. A retrospective study was carried out between October 1996 and September 2005. The records of all patients with the diagnosis of biliary atresia were retrieved. The type of procedure and clinical outcome of the patients were noted. Early failure of Kasai enterostomy was defined as the need for liver transplantation within 1-year post-Kasai operation. For the period studied, a total of 72 patients with biliary atresia were identified. Sixty-three of the 72 patients had their Kasai portoenterostomies performed openly while nine patients underwent laparoscopic Kasai portoenterostomy in a center experienced in laparoscopic surgery. Six of these patients were referred for transplantation within 1 year, giving the early failure rate of 66.6%. In comparison, the early failure rate for open Kasai procedure was 38.5%. Regarding post-operative complications, one patient who underwent laparoscopic Kasai procedure also suffered intestinal volvulus after initial surgery and another was found to have internal herniation of the Roux loop. Laparoscopic Kasai portoenterostomy seems to be associated with more post-operative complications and worse early clinical outcome. As a result, we remain guarded about the present-day technique of laparoscopy for biliary atresia.

Keywords

Biliary atresia Laparoscopy Kasai portoenterostomy Liver transplantation 

References

  1. 1.
    Bates MD, Bucuvalas JC, Alonso MH et al (1998) Biliary atresia: pathogenesis and treatment. Semin Liver Dis 18:281–293PubMedCrossRefGoogle Scholar
  2. 2.
    Kasai M, Suzuki S (1959) A new operation for “non-correctable” biliary atresia: hepatic portoenterostomy. Shujjutsu 13:733Google Scholar
  3. 3.
    Van Heurn ELW, Saing H, Tam PK (2003) Cholangitis after hepatic portoenterostomy for biliary atresia: a multivariate analysis of risk factors. J Pediatr 142:566–571. doi: 10.1067/mpd.2003.195 CrossRefGoogle Scholar
  4. 4.
    Van Heurn ELW, Saing H, Tam PK (2004) The portoenterostomy for biliary atresia: long-term survival and prognosis after esophageal variceal bleeding. J Pediatr Surg 39:6–9. doi: 10.1016/j.jpedsurg.2003.09.019 PubMedCrossRefGoogle Scholar
  5. 5.
    Altman RP, Lilly JR, Greenfield J et al (1997) A multivariable risk factor analysis of the portoenterostomy (Kasai) procedure for biliary atresia: twenty-five years of experience from two centers. Ann Surg 226:348–353. doi: 10.1097/00000658-199709000-00014 PubMedCrossRefGoogle Scholar
  6. 6.
    Hung PY, Chen CC, Chen WJ et al (2006) Long-term prognosis of patients with biliary atresia: a 25 year summary. J Pediatr Gastroenterol Nutr 42:190–195. doi: 10.1097/01.mpg.0000189339.92891.64 PubMedCrossRefGoogle Scholar
  7. 7.
    Esteves E, Clemente Neto E, Ottaiano Neto M et al (2002) Laparoscopic Kasai portoenterostomy for biliary atresia. Pediatr Surg Int 18:737–740PubMedGoogle Scholar
  8. 8.
    Lee H, Hirose S, Bratton B et al (2004) Initial experience with complex laparoscopic biliary surgery in children: biliary atresia and choledochal cyst. J Pediatr Surg 39:804–807. doi: 10.1016/j.jpedsurg.2004.02.018 PubMedCrossRefGoogle Scholar
  9. 9.
    Martinez-Ferro M, Esteves E, Laje P (2005) Laparoscopic treatment of biliary atresia and choledochal cyst. Semin Pediatr Surg 14:206–215. doi: 10.1053/j.sempedsurg.2005.06.003 PubMedCrossRefGoogle Scholar
  10. 10.
    Dutta S, Woo R, Albanese CT (2007) Minimal access portoenterostomy: advantages and disadvantages of standard laparoscopic and robotic techniques. J Laparoendosc Adv Surg Tech A 17:258–264. doi: 10.1089/lap.2006.0112 PubMedCrossRefGoogle Scholar
  11. 11.
    Rothenberg SS (2002) Thoracoscopic repair of tracheoesophageal fistula in newborns. J Pediatr Surg 37:869–872. doi: 10.1053/jpsu.2002.32891 PubMedCrossRefGoogle Scholar
  12. 12.
    Allal H, Kalfa N, Lopez M et al (2005) Benefits of the thoracoscopic approach for short- or long-gap esophageal atresia. J Laparoendosc Adv Surg Tech A 15:673–677. doi: 10.1089/lap.2005.15.673 PubMedCrossRefGoogle Scholar
  13. 13.
    Holcomb GW 3rd, Rothenberg SS, Bax KM et al (2005) Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis. Ann Surg 242:422–428PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Kenneth K. Y. Wong
    • 1
  • Patrick H. Y. Chung
    • 1
  • Kwong-leung Chan
    • 1
  • Sheung-tat Fan
    • 1
  • Paul K. H. Tam
    • 1
  1. 1.Department of SurgeryUniversity of Hong Kong Medical Center, Queen Mary HospitalHong Kong SARChina

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