Laparoscopic Kasai portoenterostomy is advantageous over open Kasai portoenterostomy in subsequent liver transplantation

Abstract

Background

Native liver survival after laparoscopic Kasai portoenterostomy (Lap-PE) for biliary atresia (BA) is controversial. We examined whether a jaundice-free native liver survival rate is comparable between conventional Kasai portoenterostomy (Open-PE) and Lap-PE. Then, the impact of the two types of PE on subsequent living-donor liver transplantation (LTx) was addressed in this study.

Methods

The jaundice-free rate in 1- and 2-year-old patients who underwent Open-PE and Lap-PE from January 2006 to December 2017 was investigated. Additionally, perioperative data (duration from the start of surgery to the completion of hepatectomy and others) of patients aged 2 years or younger who underwent LTx after either Open-PE or Lap-PE from 2006 to 2017 were evaluated.

Results

Thirty-one (67%) out of 46 Open-PE patients and 23 (77%) out of 30 Lap-PE patients showed native liver survival with jaundice-free status at 1 year of age (p = 0.384); 29 (63%) out of 46 Open-PE patients and 19 (70%) out of 27 Lap-PE patients showed native liver survival with jaundice-free status at 2 years of age (p = 0.524); there were no significant differences. Additionally, there were 37 LTx cases after PE within 2 years of birth, including 29 Open-PE and 8 Lap-PE cases. The patients in the Lap-PE group had fewer adhesions and significantly shorter durations of surgery up to the completion of the recipient’s hepatectomy and durations of post-LTx hospital stay compared to the Open-PE group. There were no differences in blood loss or duration of stay in intensive care unit between the Lap-PE and Open-PE groups.

Conclusions

Jaundice-free native liver survival rate has been comparable between Open-PE and Lap-PE. Lap-PE resulted in fewer adhesions, contributing to better outcomes of subsequent LTx compared to Open-PE.

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No funding was provided for this study.

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Correspondence to Hiroo Uchida.

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Disclosures

Drs. Chiyoe Shirota, Naruhiko Murase, Yujiro Tanaka, Yasuhiro Ogura, Hideya Kamei, Nobuhiko Kurata, Masahiro Nakatochi, Akinari Hinoki, Takahisa Tainaka, Wataru Sumida, Kazuki Yokota, Satoshi Makita, Kazuo Oshima, and Hiroo Uchida have no conflicts of interest or financial ties to disclose.

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Shirota, C., Murase, N., Tanaka, Y. et al. Laparoscopic Kasai portoenterostomy is advantageous over open Kasai portoenterostomy in subsequent liver transplantation. Surg Endosc 34, 3375–3381 (2020). https://doi.org/10.1007/s00464-019-07108-y

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Keywords

  • Biliary atresia
  • Laparoscopic Kasai portoenterostomy
  • Liver transplantation
  • Adhesion
  • Revision of Kasai portoenterostomy