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Classification of biliary atresia in the laparoscopic era

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Abstract

Purpose

According to Kasai’s classification of biliary atresia (BA), type III is diagnosed when micro bile ducts (MBD) cannot be identified macroscopically on the surface of the biliary remnant transected at the porta hepatis. However, during laparoscopic Kasai (lapKasai), magnification produced by a 30° 10 mm scope at a focal length of 5 cm is ×38 and ×100 when zooming, enabling more MBD to be identified than with the naked eye rendering Kasai’s original classification questionable in the laparoscopic era.

Methods

Intraoperative video recordings of 36 consecutive lapKasai cases (2009–2015) were reviewed to confirm MBD visibility. 85 consecutive open Kasai cases examined macroscopically served as controls.

Results

MBD were not visible under regular laparoscopic magnification during lapKasai in 6/36 (lapMBD−; 16.7 %) cases and visible in 30/36 (83.3 %). However, in open cases, MBD could not be identified macroscopically in 77/85 (macroMBD−; 90.6 %), a typical result reported internationally. For our lapKasai cases, jaundice clearance was lower in lapMBD-cases (4/6 = 66.7 % versus 26/30 = 86.7 %), which was not statistically significant (p = 0.26).  Conversely, survival with the native liver was significantly lower in lapMBD-cases (4/6 = 66.7 % versus 23/30 = 76.7 %) (p < 0.05).

Conclusions

BA classification may benefit from revision to include laparoscopic findings to categorize BA more comprehensively.

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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, Joel Cazares, Geoffrey J. Lane & Atsuyuki Yamataka

  2. Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Naruhiko Murase & Hiroo Uchida

  3. Department of Pediatric Surgery, Hospital Regional de Alta Especialidad Materno Infantil, Monterrey, Mexico

    Joel Cazares

Authors
  1. Hiroki Nakamura
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  2. Naruhiko Murase
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  3. Hiroyuki Koga
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  4. Joel Cazares
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  5. Geoffrey J. Lane
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  6. Hiroo Uchida
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  7. Atsuyuki Yamataka
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Corresponding author

Correspondence to Hiroki Nakamura.

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Nakamura, H., Murase, N., Koga, H. et al. Classification of biliary atresia in the laparoscopic era. Pediatr Surg Int 32, 1209–1212 (2016). https://doi.org/10.1007/s00383-016-3973-3

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  • DOI: https://doi.org/10.1007/s00383-016-3973-3

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