Comparison of laparoscopic portoenterostomy and open portoenterostomy for the treatment of biliary atresia
Although open portoenterostomy (OPE) is considered the standard treatment for biliary atresia (BA), laparoscopic portoenterostomy (LPE) is conducted and reported by many investigators. Data on the safety and efficacy of LPE remain controversial. The aim of this meta-analysis is to compare the safety and efficacy of LPE and OPE for the treatment of BA.
Three electronic databases were searched: PubMed, Embase, and the Cochrane Library. The eligible studies were limited to those published in English. The following keywords were used: “biliary atresia,” “laparoscopic portoenterostomy,” “Kasai portoenterostomy,” “open portoenterostomy,” “surgery,” and “treatment.”
Nine studies, including 434 patients, were analyzed. The operative time of LPE was significantly longer than that of OPE (MD = 40.55 min, 95% CI 4.83–76.27 min, P = 0.03). There was no significant difference between the two groups in terms of the time of hospital stay, the volume of intraoperative blood loss, or the rates of cholangitis, early clearance of jaundice or two-year survival with the native liver. The subgroup analyses revealed that the rate of early clearance of jaundice in the LPE group was significantly higher than that in the OPE group in studies published after 2016 (95% CI 1.04–1.75; P = 0.02).
The present meta-analysis provides evidence that LPE is a feasible option for patients with BA. LPE should be revaluated by further studies and longer follow-up.
KeywordsPediatric Biliary atresia Laparoscopy Portoenterostomy
This project was supported by grants from the National Natural Science Foundation of China (Grants 81401606 and 81400862), the Key Project in the Science & Technology Program of Sichuan Province (Grant 19ZDYF1454), and the Science Foundation for The Excellent Youth Scholars of Sichuan University (Grant 2015SU04A15).
Compliance with ethical standards
Yanan Li, Chuan Wang, Jinran Gan, Zhicheng Xu, Yiyang Zhao, and Yi Ji have no conflicts of interest or financial ties to disclose.
- 5.Msm K (1959) A new operation for non-correctable biliary atresia: hepatic portoenterostomy. Shujutsu 13:733–739Google Scholar
- 8.Shneider BL, Brown MB, Haber B, Whitington PF, Schwarz K, Squires R, Bezerra J, Shepherd R, Rosenthal P, Hoofnagle JH, Sokol RJ, Biliary Atresia Research C (2006) A multicenter study of the outcome of biliary atresia in the United States, 1997 to 2000. J Pediatr 148(4):467–474. https://doi.org/10.1016/j.jpeds.2005.12.054 CrossRefGoogle Scholar
- 13.Chan KW, Lee KH, Wong HY, Tsui SY, Wong YS, Pang KY, Mou JW, Tam YH (2014) From laparoscopic to open Kasai portoenterostomy: the outcome after reintroduction of open Kasai portoenterostomy in infant with biliary atresia. Pediatr Surg Int 30(6):605–608. https://doi.org/10.1007/s00383-014-3499-5 CrossRefGoogle Scholar
- 14.Ure BM, Kuebler JF, Schukfeh N, Engelmann C, Dingemann J, Petersen C (2011) Survival with the native liver after laparoscopic versus conventional Kasai portoenterostomy in infants with biliary atresia: a prospective trial. Ann Surg 253(4):826–830. https://doi.org/10.1097/SLA.0b013e318211d7d8 CrossRefGoogle Scholar
- 15.Bax N, Georgeson K (2007) Biliary atresia panel session. In: Presentation at the 16th annual congress of the International Pediatric Endosurgery Group (IPEG). Buenos Aires: 6–9Google Scholar
- 16.Nakamura H, Koga H, Okazaki T, Urao M, Miyano G, Okawada M, Doi T, Watayo H, Ogasawara Y, Lane GJ, Yamataka A (2015) Does pneumoperitoneum adversely affect growth, development and liver function in biliary atresia patients after laparoscopic portoenterostomy? Pediatr Surg Int 31 (1):45-51. doi:10.1007/s00383-014-3625-4Google Scholar
- 24.Wada M, Nakamura H, Koga H, Miyano G, Lane GJ, Okazaki T, Urao M, Murakami H, Kasahara M, Sakamoto S, Ishizaki Y, Kawasaki S, Yamataka A (2014) Experience of treating biliary atresia with three types of portoenterostomy at a single institution: extended, modified Kasai, and laparoscopic modified Kasai. Pediatr Surg Int 30(9):863–870. https://doi.org/10.1007/s00383-014-3551-5 CrossRefGoogle Scholar
- 28.Lishuang M, Zhen C, Guoliang Q, Zhen Z, Chen W, Long L, Shuli L (2015) Laparoscopic portoenterostomy versus open portoenterostomy for the treatment of biliary atresia: a systematic review and meta-analysis of comparative studies. Pediatr Surg Int 31(3):261–269. https://doi.org/10.1007/s00383-015-3662-7 CrossRefGoogle Scholar
- 29.Chan KW, Lee KH, Tsui SY, Wong YS, Pang KY, Mou JW, Tam YH (2012) Laparoscopic versus open Kasai portoenterostomy in infant with biliary atresia: a retrospective review on the 5-year native liver survival. Pediatr Surg Int 28(11):1109–1113. https://doi.org/10.1007/s00383-012-3172-9 CrossRefGoogle Scholar
- 36.Murase N, Hinoki A, Shirota C, Tomita H, Shimojima N, Sasaki H, Nio M, Tahara K, Kanamori Y, Shinkai M, Yamamoto H, Sugawara Y, Hibi T, Ishimaru T, Kawashima H, Koga H, Yamataka A, Uchida H (2019) Multicenter, retrospective, comparative study of laparoscopic and open Kasai portoenterostomy in children with biliary atresia from Japanese high-volume centers. J Hepatobiliary Pancreat Sci 26(1):43–50. https://doi.org/10.1002/jhbp.594 CrossRefGoogle Scholar