Skip to main content
SpringerLink
Log in

Laparoscopic Kasai portoenterostomy for cystic biliary atresia: midterm follow-up results of 35 patients

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

To investigate the clinical characteristics of cystic biliary atresia (CBA) and evaluate the midterm follow-up outcomes after laparoscopic treatment.

Methods

We analyzed and compared data retrospectively on CBA patients (group A) and nonsyndromic type III biliary atresia (BA) patients (group B), who underwent laparoscopic Kasai portoenterostomy (LKPE) during the same period.

Results

There were no significant differences in operative time, conversion rate, or the incidence of any postoperative complications between groups A and B (P > 0.05). The mean age at surgery (P < 0.01), rates of clearance of jaundice (CJ), cholangitis (P < 0.05), and 5-year survival with a native liver (SNL) were significantly lower in group A than in group B. Among the 35 patients with CBA, the CJ and 5-year SNL rates were significantly better in those with type I (n = 27) than in those with type IIId (n = 8) (P < 0.05).

Conclusions

LKPE is a feasible and safe procedure for CBA. The 5-year SNL after LKPE was better in patients with CBA than in those with nonsyndromic type III BA. The 5-year SNL after LKPE for type I CBA was better than that for type IIId CBA.

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

Similar content being viewed by others

References

  1. Komuro H, Makino SI, Momoya T, Nishi A. Biliary atresia with extrahepatic biliary cysts–cholangiographic patterns influencing the prognosis. J Pediatr Surg. 2000;35(12):1771–4.

    Article  CAS  Google Scholar 

  2. Li Y, Xiang B, Wu Y, Wang C, Wang Q, Zhao Y, et al. Medium-term outcome of laparoscopic Kasai portoenterostomy for biliary atresia with 49 cases. J Pediatr Gastroenterol Nutr. 2018;66(6):857–60.

    Article  Google Scholar 

  3. Lobeck IN, Sheridan R, Lovell M, Dupree P, Tiao GM, Bove KE. Cystic biliary atresia and choledochal cysts are distinct histopathologic entities. Am J Surg Pathol. 2017;41(3):354–64.

    Article  Google Scholar 

  4. Lal R, Prasad DK, Krishna P, Sikora SS, Poddar U, Yachha SK, et al. Biliary atresia with a “cyst at porta”: management and outcome as per the cholangiographic anatomy. Pediatr Surg Int. 2007;23(8):773–8.

    Article  Google Scholar 

  5. Lilly JR, Hall RJ, Vasquez-Estevez J, Karrer F, Shikes RH. The surgery of “correctable” biliary atresia. J Pediatr Surg. 1987;22(6):522–5.

    Article  CAS  Google Scholar 

  6. Arima E, Fonkalsrud EW, Neerhout RC. Experience in the management of surgically correctable biliary atresia. Surgery. 1974;75(2):228–32.

    CAS  PubMed  Google Scholar 

  7. Nio M. Japanese biliary atresia registry. Pediatr Surg Int. 2017;33(12):1319–25.

    Article  Google Scholar 

  8. Nio M, Wada M, Sasaki H, Tanaka H. Does hepatic hilum morphology influence long-term prognosis in type I/I cyst biliary atresia? Pediatr Surg Int. 2015;31(10):931–6.

    Article  Google Scholar 

  9. Redkar R, Davenport M, Howard ER. Antenatal diagnosis of congenital anomalies of the biliary tract. J Pediatr Surg. 1998;33(5):700–4.

    Article  CAS  Google Scholar 

  10. Hasegawa T, Sasaki T, Kimura T, Sawai T, Nose K, Kamata S, et al. Prenatal ultrasonographic appearance of type IIId (uncorrectable type with cystic dilatation) biliary atresia. Pediatr Surg Int. 2002;18(5–6):425–8.

    CAS  PubMed  Google Scholar 

  11. Davenport M, Ville De, de Goyet J, Stringer MD, Mieli-Vergani G, Kelly DA, McClean P, et al. Seamless management of biliary atresia in England and Wales (1999–2002). Lancet. 2004;363(9418):1354–7.

    Article  Google Scholar 

  12. Davenport M, Betalli P, D’Antiga L, Cheeseman P, Mieli-Vergani G, Howard ER. The spectrum of surgical jaundice in infancy. J Pediatr Surg. 2003;38(10):1471–9.

    Article  Google Scholar 

  13. Caponcelli E, Knisely AS, Davenport M. Cystic biliary atresia: an etiologic and prognostic subgroup. J Pediatr Surg. 2008;43(9):1619–24.

    Article  Google Scholar 

  14. Davenport M, Caponcelli E, Livesey E, Hadzic N, Howard E. Surgical outcome in biliary atresia: etiology affects the influence of age at surgery. Ann Surg. 2008;247(4):694–8.

    Article  Google Scholar 

  15. Mackenzie TC, Howell LJ, Flake AW, Adzick NS. The management of prenatally diagnosed choledochal cysts. J Pediatr Surg. 2001;36(8):1241–3.

    Article  CAS  Google Scholar 

  16. Tanaka N, Ueno T, Takama Y, Fukuzawa M. Diagnosis and management of biliary cystic malformations in neonates. J Pediatr Surg. 2010;45(11):2119–23.

    Article  Google Scholar 

  17. Huang FC, Hwang KP. Differential diagnosis of infantile choledochal cyst with or without biliary atresia. Acta Paediatr Taiwan. 2006;47(4):175–80.

    PubMed  Google Scholar 

  18. Obaidah A, Dhende NP, Mane SB, Acharya H. Biliary atresia associated with choledochal cyst. Afr J Paediatr Surg. 2009;6(1):61–2.

    Article  Google Scholar 

  19. Nio M, Sano N, Ishii T, Sasaki H, Hayashi Y, Ohi R. Long-term outcome in type I biliary atresia. J Pediatr Surg. 2006;41(12):1973–5.

    Article  Google Scholar 

  20. Takahashi Y, Matsuura T, Saeki I, Zaizen Y, Taguchi T. Excellent long-term outcome of hepaticojejunostomy for biliary atresia with a hilar cyst. J Pediatr Surg. 2009;44(12):2312–5.

    Article  Google Scholar 

  21. Ji Y, Yang K, Zhang X, Chen S, Xu Z. Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases. BMC Surg. 2018;18(1):107.

    Article  Google Scholar 

  22. Wong KK, Chung PH, Chan KL, Fan ST, Tam PK. Should open Kasai portoenterostomy be performed for biliary atresia in the era of laparoscopy? Pediatr Surg Int. 2008;24(8):931–3.

    Article  Google Scholar 

  23. Murase N, Hinoki A, Shirota C, Tomita H, Shimojima N, Sasaki H, et al. Multicenter, retrospective, comparative study of laparoscopic and open Kasai portoenterostomy in children with biliary atresia from Japanese high-volume centers. J Hepatobiliary Pancreat Sci. 2019;26(1):43–50.

    Article  Google Scholar 

  24. Shirota C, Murase N, Tanaka Y, Ogura Y, Nakatochi M, Kamei H, et al. Laparoscopic Kasai portoenterostomy is advantageous over open Kasai portoenterostomy in subsequent liver transplantation. Surg Endosc. 2020;34(8):3375–81.

    Article  Google Scholar 

  25. Li Y, Gan J, Wang C, Xu Z, Zhao Y, Ji Y. Comparison of laparoscopic portoenterostomy and open portoenterostomy for the treatment of biliary atresia. Surg Endosc. 2019;33(10):3143–52.

    Article  Google Scholar 

  26. Masumoto K, Kai H, Oka Y, Otake R, Yoshizato T, Miyamoto S, et al. A case of cystic biliary atresia with an antenatally detected cyst: the possibility of changing from a correctable type with a cystic lesion (I cyst) to an uncorrectable one (IIId). Pediatr Surg Int. 2011;27(1):99–102.

    Article  Google Scholar 

  27. Faure A, Hery G, Colavolpe N, Bevilacqua C, Guys JM, De Lagausie P. Laparoscopic cystojejunostomy for type I cystic biliary atresia in children. J Minim Access Surg. 2015;11(4):263–6.

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by grants from the National Natural Science Foundation of China (Grant No: 81401606 and 81400862), the Key Project in the Science & Technology Program of Sichuan Province (Grant No: 2019YFS0322), the Science Foundation for Excellent Youth Scholars of Sichuan University (Grant No: 2015SCU04A15), and the 1·3·5 Project for Disciplines of Excellence–Clinical Research Incubation Project, West China Hospital of Sichuan University (Grant No: 2019HXFH056 and 2020HXFH048).

Author information

Author notes

  1. Yi Ji and Jianyuan Zhou contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Surgery, West China Hospital of Sichuan University, #37 Guo-Xue-Xiang, Chengdu, 610041, Sichuan, China

    Yi Ji, Jianyuan Zhou, Xuepeng Zhang & Zhicheng Xu

  2. Department of Critical Care Medicine, Pediatric Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, 610041, China

    Siyuan Chen

Authors
  1. Yi Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jianyuan Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xuepeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Siyuan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhicheng Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YJ, JYZ, XPZ, SYC, and ZCX were involved in the clinical management of the patients and collected clinical details for this study. JYZ reviewed the literature and drafted the manuscript. YJ reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Zhicheng Xu.

Ethics declarations

Conflicts of interest

We have no conflicts of interest to declare in association with the present study.

Ethical approval and consent to participate

The Ethics Committee of the West China Hospital of Sichuan University approved the study. Written informed consent was obtained from the patients’ parents according to the provisions of the Declaration of Helsinki.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ji, Y., Zhou, J., Zhang, X. et al. Laparoscopic Kasai portoenterostomy for cystic biliary atresia: midterm follow-up results of 35 patients. Surg Today 51, 1924–1931 (2021). https://doi.org/10.1007/s00595-021-02297-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-021-02297-3

Keywords

Search

Navigation