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Laparoscopic revision of Kasai portoenterostomy after initial laparoscopic portoenterostomy in patients with biliary atresia: a limited but positive effect on native liver survival

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Abstract

Purpose

It is important for patients with biliary atresia (BA) to retain the native liver after Kasai portoenterostomy (PE). Laparoscopic PE (Lap-PE) is standard, whereas laparoscopic revision of PE (Lap-revision) is performed as needed. We report the medium-term outcomes of Lap-revision.

Methods

We retrospectively reviewed the demographics and outcomes of 63 patients who underwent Lap-PE between 2013 and 2021. Indications for revision included recurrent jaundice, repeat cholangitis, and persistent jaundice with temporary biliary excretion following the initial PE. We compared liver transplantation (LT) data of patients who underwent Lap-revision with those of patients who did not.

Results

Lap-revision was performed in 20 patients. Of those 17 (excluding the two who were jaundice-free before the age of 1, and the one who underwent open conversion for bleeding), 11 (65%) were jaundice-free 1 year after Lap-revision. The surgical parameters of LT did not differ between patients who underwent Lap-revision and those who did not.

Conclusion

Lap-revision for patients with BA had a limited but positive effect on native liver survival and did not adversely affect subsequent LT. Therefore, Lap-revision could be second-line standard therapy in patients with BA who have demonstrated biliary drainage at least once after initial PE.

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References

  1. Nio M, Sasaki H, Tanaka H, Okamura A (2013) Redo surgery for biliary atresia. Pediatr Surg Int 29:989–993. https://doi.org/10.1007/s00383-013-3396-3

    Article  PubMed  Google Scholar 

  2. Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713. https://doi.org/10.1016/S0140-6736(09)60946-6

    Article  PubMed  Google Scholar 

  3. Mendoza MM, Chiang J-H, Lee S-Y et al (2012) Reappraise the effect of redo-Kasai for recurrent jaundice following Kasai operation for biliary atresia in the era of liver transplantation. Pediatr Surg Int 28:861–864. https://doi.org/10.1007/s00383-012-3154-y

    Article  PubMed  Google Scholar 

  4. Bondoc AJ, Taylor JA, Alonso MH et al (2012) The beneficial impact of revision of Kasai portoenterostomy for biliary atresia: an institutional study. Ann Surg 255:570–576. https://doi.org/10.1097/SLA.0b013e318243a46e

    Article  PubMed  Google Scholar 

  5. Shirota C, Uchida H, Ono Y et al (2016) Long-term outcomes after revision of Kasai portoenterostomy for biliary atresia. J Hepatobiliary Pancreat Sci 23:715–720. https://doi.org/10.1002/jhbp.395

    Article  PubMed  Google Scholar 

  6. Murase N, Uchida H, Ono Y et al (2015) A new era of laparoscopic revision of Kasai portoenterostomy for the treatment of biliary atresia. Biomed Res Int 2015:173014. https://doi.org/10.1155/2015/173014

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ji Y, Zhang X, Chen S et al (2021) Medium-term outcomes after laparoscopic revision of laparoscopic Kasai portoenterostomy in patients with biliary atresia. Orphanet J Rare Dis 16:193. https://doi.org/10.1186/s13023-021-01835-z

    Article  PubMed  PubMed Central  Google Scholar 

  8. Amano H, Uchida H, Kawashima H et al (2015) The umbilical Benz incision for reduced port surgery in pediatric patients. JSLS 19(e2014):00238. https://doi.org/10.4293/JSLS.2014.00238

    Article  PubMed  Google Scholar 

  9. Uchida H, Shirota C, Tainaka T (2021) Operative procedures: laparoscopic kasai procedure. In: Nio M (ed) Introduction to biliary atresia. Springer, Singapore, pp 147–156

    Chapter  Google Scholar 

  10. Shirota C, Hinoki A, Tainaka T et al (2022) Laparoscopic Kasai portoenterostomy can be a standard surgical procedure for treatment of biliary atresia. World J Gastrointest Surg 14:56–63. https://doi.org/10.4240/wjgs.v14.i1.56

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gallo A, Esquivel CO (2013) Current options for management of biliary atresia. Pediatr Transplant 17:95–98. https://doi.org/10.1111/petr.12040

    Article  PubMed  Google Scholar 

  12. Urahashi T, Ihara Y, Sanada Y et al (2013) Effect of repeat Kasai hepatic portoenterostomy on pediatric live-donor liver graft for biliary atresia. Exp Clin Transplant 11:259–263. https://doi.org/10.6002/ect.2012.0188

    Article  PubMed  Google Scholar 

  13. Sugawara Y, Makuuchi M, Kaneko J et al (2004) Impact of previous multiple portoenterostomies on living donor liver transplantation for biliary atresia. Hepatogastroenterology 51:192–194

    PubMed  Google Scholar 

  14. Shneider BL, Brown MB, Haber B et al (2006) A multicenter study of the outcome of biliary atresia in the United States, 1997 to 2000. J Pediatr 148:467–474. https://doi.org/10.1016/j.jpeds.2005.12.054

    Article  PubMed  Google Scholar 

  15. Mukhopadhyay SG, Roy P, Chatterjee U et al (2014) A histopathological study of liver and biliary remnants in the long-term survivors (>10 years) of cases of biliary atresia. Indian J Pathol Microbiol 57:380. https://doi.org/10.4103/0377-4929.138722

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Daiki Kato, Hiroo Uchida, Hizuru Amano, Chiyoe Shirota, Wataru Sumida, Kazuki Yokota, Satoshi Makita, Masamune Okamoto, Aitaro Takimoto, Akihiro Yasui, Shunya Takada & Yoichi Nakagawa

  2. Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Akinari Hinoki

Authors
  1. Daiki Kato
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  2. Hiroo Uchida
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  3. Hizuru Amano
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  4. Akinari Hinoki
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  5. Chiyoe Shirota
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  6. Wataru Sumida
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Contributions

DK participated in the planning, conducting of the study, interpretation of data, collection, and writing of manuscript. HU contributed to interpretation and critically reviewed the manuscript. All the authors approved the final submitted draft of this manuscript.

Corresponding author

Correspondence to Hiroo Uchida.

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The authors declare no competing interests that are relevant to the content of this article.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent to participate in the study was obtained from the parents of all individual participants.

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Kato, D., Uchida, H., Amano, H. et al. Laparoscopic revision of Kasai portoenterostomy after initial laparoscopic portoenterostomy in patients with biliary atresia: a limited but positive effect on native liver survival. Pediatr Surg Int 38, 1821–1827 (2022). https://doi.org/10.1007/s00383-022-05235-7

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