Comparative study of open and laparoscopic Kasai portoenterostomy in children undergoing living donor liver transplantation for biliary atresia

Purpose The effectiveness of laparoscopic Kasai portoenterostomy (Laparoscopic-KPE) for biliary atresia (BA) has been reported but remains controversial. We reviewed our own cases and cases described in previous studies of liver transplantation (LT) for BA after Laparoscopic-KPE to investigate the e...

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Bibliographic Details
Published in:Pediatric surgery international 2021-12, Vol.37 (12), p.1683-1691
Main Authors: Takeda, Masahiro, Sakamoto, Seisuke, Uchida, Hajime, Shimizu, Seiichi, Yanagi, Yusuke, Fukuda, Akinari, Uchida, Hiroo, Yamataka, Atsuyuki, Kasahara, Mureo
Format: Article
Language:English
Subjects:
Biliary Atresia - surgery
Child
Child, Preschool
Childrens health
Hepatectomy
Humans
Infant
Laparoscopy
Laparotomy
Liver
Liver Transplantation
Liver transplants
Living Donors
Medicine
Medicine & Public Health
Original Article
Pediatric Surgery
Pediatrics
Portoenterostomy, Hepatic
Retrospective Studies
Surgery
Surgical outcomes
Transplants & implants
Treatment Outcome
Veins & arteries
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Summary:Purpose The effectiveness of laparoscopic Kasai portoenterostomy (Laparoscopic-KPE) for biliary atresia (BA) has been reported but remains controversial. We reviewed our own cases and cases described in previous studies of liver transplantation (LT) for BA after Laparoscopic-KPE to investigate the efficacy of Laparoscopic-KPE. Methods Subjects were children of  ≤ 2 years old with LT for BA after KPE who underwent Laparoscopic-KPE ( n  = 10) or Open-KPE ( n  = 115) between 2009 and 2020. Propensity score matching was performed to reduce the effect of treatment selection bias. The clinical data regarding the preoperative characteristics and surgical results were compared. Results The rates of hypoplastic portal vein and retrograde portal vein flow were lower in the Laparoscopic-KPE group than in the Open-KPE group (0 vs. 40.0%, p  = 0.02 and 0 vs. 35.0%, p  = 0.04). There was no marked difference in the operation time or duration of hepatectomy. For portal vein reconstruction, a vein graft was not required in the Laparoscopic-KPE group (0 vs. 35.0%, p  = 0.03). No patients in the Laparoscopic-KPE group developed portal vein complications or required re-laparotomy for bowel perforation or re-bleeding, in contrast to the Open-KPE group (0 vs. 15.0% and 0 vs. 10.0%, respectively). Conclusion Laparoscopic-KPE may reduce postoperative complications that necessitate re-laparotomy in LT.
ISSN:0179-0358
1437-9813
DOI:10.1007/s00383-021-04994-z