Experience of treating biliary atresia with three types of portoenterostomy at a single institution: extended, modified Kasai, and laparoscopic modified Kasai
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Generally, open portoenterostomy (PE) involves a wide extended anastomosis and all sutures are deep [extended PE (EP)]. In contrast, the anastomosis in Kasai’s PE (KP), our modified open Kasai PE (MK), and our laparoscopic modified Kasai PE (lapMK) involve shallow suturing, especially at the 2 and 10 o’clock positions where the right and left bile ducts would be normally. We compared outcomes of 36 consecutive biliary atresia (BA) patients treated by three types of PE at a single institution during the period 2005–2014; EP (n = 13), MK (n = 11), and lapMK (n = 12).
We compared age at PE, time taken to become jaundice-free (total bilirubin ≤1.2 mg/dL; JF time), proportion of JF subjects [JF ratio (JFR)], steroid dosage, incidence of cholangitis, postoperative liver function and CRP, presence of hypersplenism, requirement for liver transplantation (LTx), and JF survival with the native liver (JF+NL) as indicators of outcome.
Patient demographics, steroid dosage, JF time, incidence of cholangitis, presence of hypersplenism, operating time, blood loss and postoperative biochemistry were similar for all groups. However, JFR was significantly higher for lapMK (100 %) versus EP (46.2 %) (p < 0.05), but not for MK (81.8 %) versus EP. Kaplan–Meier analysis showed survival with NL was significantly higher for lapMK (10/12: 83.3 %: JF in 9; not JF in 1) and MK (9/11: 81.8 %: JF in all) versus EP (3/13: 23.1 %: JF in all) (p < 0.05, respectively), but not for lapMK versus MK. JF+NL in both lapMK (9/12: 75.0 %) and MK (9/11: 81.8 %) were significantly higher compared with EP (3/13: 23.1 %) (p < 0.05, respectively). Intraperitoneal adhesions were less pronounced at LTx in lapMK compared with MK or EP.
This study would suggest that depth of suturing during PE would appear to influence post-PE outcome. LapMK should be reconsidered as a valid treatment option for BA.
KeywordsBiliary atresia Portoenterostomy Laparoscopy Extended anastomosis
- 1.Kasai M, Suzuki S (1959) A new operation for non-correctable biliary atresia: hepatic portoenterostomy. Shujutu 13:733–779Google Scholar
- 3.Karrer FM, Pence JC (2003) Biliary atresia and choledochal cyst. In: Ziegler MM, Azizkhan RG, Weber TR (eds) Operative pediatric surgery, 5th edn. McGraw-Hill, New York, pp 775–787Google Scholar
- 8.Bax NMA, Georgeson K (2007) Biliary atresia panel session. In: Presentation at the 16th annual congress of the International Pediatric Endosurgery Group, Buenos Aires, Argentina, 6–9 SeptemberGoogle Scholar
- 11.Nakamura H, Koga H, Miyano G et al. (2013) Gastrointestinal and hepatobiliary scientific session. In: Presentation at the 22nd annual congress of the International Pediatric Endosurgery Group, Beijing, China, 17–22 JuneGoogle Scholar
- 17.Ohi R (1999) Portoenterostomy for Biliary atresia. Japan surgical society video library no. 99-05Google Scholar
- 18.Kasai M (1978) Surgery for biliary atresia. Japan surgical society video library no. 78-07Google Scholar
- 20.Nio M, Sasaki H, Wada M et al (2010) The validity of currently performed procedures for treating biliary atresia based on postsurgical outcome at our center (abstract in Japanese). J Jpn Soc Pediatr Surg 46:430Google Scholar
- 21.Yamataka A, Koga H, Miyano G et al (2009) Laparoscopic portoenterostomy for biliary atresia: our experience (Abstract in Japanese). In: Presentation at the 36th annual congress of the Japan biliary atresia society, Yokohama, Japan, 12 DecemberGoogle Scholar