Laparoscopic portoenterostomy for biliary atresia: single-center experience and review of literatures.

Abstract

The aim of this report was to present the laparoscopic portoenterostomy (LapPE) procedure developed by the Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine (JLapPE). We also attempted to obtain an understanding of the current status of laparoscopic portoenterostomy in the world as reported in the English literature to compare with our experience. There were 22 BA patients who had JLapPE between 2009 and 2016. BA classification was type III (n = 19) and type II (n = 3). There was 1 case of syndromic BA and 1 case was positive for cytomegalovirus. A systematic search in PubMed of all BA patients treated by LapPE in the English literature was conducted. Jaundice clearance (JC) and survival with the native liver (SNL) were compared. Mean age at JLapPE was 67.1days (range 29-119). Mean postoperative follow-up was 4.6years (1.3-8.3). Mean operative time was 514min (240-662) and mean blood loss was 13.4g (3-21). Postoperative JC (Total bilirubin ≤ 1.5mg/dL) was 77.3% (17/22) at 3months and 90.9% (20/22) at 6months. SNL at 6months of age was 90.9% (20/22); at 1year of age was 77.3% (17/22), at 2years of age was 73.7% (14/19); and at 3years of age was 81.3% (13/16). Despite recent reports that outcome of LapPE for BA may be unfavorable compared with the conventional open portoenterostomy, our results would suggest that JLapPE can be performed successfully, because it is performed exactingly according to a standard protocol. JLapPE will continue to be our procedure of choice for treating BA.