Laparoscopic versus open Kasai portoenterostomy in infants with type III biliary atresia: a prospective study

Abstract

Objective To compare the clinical outcomes in laparoscopic versus conventional Kasai portoenterostomy in patients with type Ⅲ biliary atresia.Methods Ninety-five patients with type Ⅲ biliary atresia underwent Kasai operation in the Capital Pediatric Institution between September 2009 and August 2011.They were randomized assigned into 2 groups according to the surgical procedures:laparoscopic Kasai portoenterostomy group (LP group,n =48) and open Kasai portoenterostomy group (OP group,n =47).In LP group,4 patients were converted to open surgery during operation.The rest 44 cases of the LP group and 47 cases of OP group were recruited in this study.The clinical data including intraoperative blood loss,operation time,postoperative hospital stay,start of food intake,liver function improvement,jaundice clearance rate,incidence of cholangitis,postoperative complications and mortality were analyzed.Results There were no significant differences of patients' gender and age at operation between the LP group and the OP groups.Compared with those underwent open surgery,the patients underwent laparoscopic Kasai procedure had a longer operation time (172.32 ± 29 min vs.149.66 ± 27.91 min,P＜0.01),less intraoperative blood loss (8.07 ± 3.09 ml vs.17.55 ± 3.59ml,P＜0.01),and earlier start of food intake after surgery (2.80 ± 1.36 days vs.3.47 ± 0.65 days,P =0.02).However,no statistical difference of postoperative hospital stay was found between these 2 groups (LP 12.55 ± 3.92 days vs.OP 13.57 ± 3.03 days,P =0.16).The median follow-up period was 16 months of the LP group and 17 months of the OP group.There are no significant differences between these 2 groups in postoperative jaundice clearance rate (LP 43.18 ％ vs.OP 51.06％,P =0.45),incidence of cholangitis (LP 59.09％ vs.OP 59.57％,P =0.96),mortality (6 months after surgery:LP 18.18％ vs.OP 14.89％,P =0.67; 1 year after surgery:LP 21.88％vs.OP 27.78％,P =0.58),and liver function improvement after operation.Conclusions This prospective study shows the laparoscopic Kasai procedure for biliary atresia is technically feasible.However,laparoscopic Kasai portoenterostomy is not superior to open surgery in the improvement of native liver survival. Key words: Biliary atresia; Laparoscopy; Anastomosis, surgical