A prospective study comparing laparoscopic and conventional Kasai portoenterostomy in children with biliary atresia

Sun, Xu; Diao, Mei; Wu, Xuanzhao; Wei, Cheng; Ye, Mao; Li, Long

doi:10.1016/j.jpedsurg.2015.10.045

Cited by 41 publications

(14 citation statements)

References 11 publications

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“…Laparoscopic portoenterostomy has not been shown to have better outcome than the open portoenterostomy[75]. Although proponents have defended the minimal access approach with the claim that the risk for damage to small bile ductules around the porta hepatis is minimal, due to avoidance of deep suturing and extensive dissection[76].…”

Section: Operative Managementmentioning

confidence: 99%

Biliary atresia: Where do we stand now?

Govindarajan

2016

WJH

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The pathway from clinical suspicion to establishing the diagnosis of biliary atresia in a child with jaundice is a daunting task. However, investigations available help to point towards the correct diagnosis in reasonable time frame. Imaging by Sonography has identified several parameters which can be of utility in the diagnostic work up. Comparison of Sonography with imaging by Nuclear medicine can bring out the significant differences and also help in appropriate imaging. The battery of Biochemical tests, available currently, enable better understanding of the line-up of investigations in a given child with neonatal cholestasis. Management protocols enable standardized care with optimal outcome. The place of surgical management in biliary atresia is undisputed, although Kasai procedure and primary liver transplantation have been pitted against each other. This article functions as a platform to bring forth the various dimensions of biliary atresia.

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Section: Operative Managementmentioning

confidence: 99%

Biliary atresia: Where do we stand now?

Govindarajan

2016

WJH

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“…Although the outcomes of LKPE are not satisfied with OKPE in some reports [ 6 , 22 , 23 ], our recent study revealed that the 3-year and 5 year SNL rates after LKPE were not different compared to those after OKPE. Because BA is a rare disease, the experiences of LKPE are incapable to be cumulated to proficiency in a short time, especially in hospitals or centers with the low caseload of BA.…”

Section: Discussionmentioning

confidence: 61%

“…Previously, LKPE had not been showed to be as efficacious as the open Kasai portoenterostomy (OKPE) [ 2 – 4 ]. However, recent reports revealed that the 3- and 5-year survivals with native liver (SNL) after LKPE were not inferior to that after OKPE [ 5 , 6 ]. Similar to other laparoscopic procedures, a learning curve may exist for LKPE, which, if identified, may allow new adopters to improve their insight.…”

Section: Introductionmentioning

confidence: 99%

Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases

Yang

Zhang

et al. 2018

BMC Surg

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BackgroundLaparoscopic Kasai portoenterostomy (LKPE) is performed for biliary atresia (BA). As LKPE is a technically demanding operation, a learning curve should be defined to guide training. The aim of this study was to identify the learning curve of LKPE for BA.MethodsMetrics of perioperative safety and efficiency for 100 cases of LKPE were evaluated. Outcomes were followed to 67.2 ± 12.1 months. Cumulative sum (CUSUM) analysis was used to identify inflexion point corresponding to the learning curve. Outcome measures included operative time (ORT), rate of clearance of jaundice (CJ) and survival with native liver (SNL).ResultsBetween May 2009 and May 2013, 100 consecutive patients with BA underwent LKPE. The rate of conversion from LKPE to open Kasai portoenterostomy (OKPE), intraoperative transfusion and any perioperative complications was 11, 26 and 16%, respectively. There was no perioperative mortality. The CUSUM analysis revealed a learning curve of 50 for LKPE. Precipitous ORT reductions from an initial mean operative time of 316.3 min that was observed in the first 50 to 232.2 min of the late 50 cases (P < 0.01). Subsequently, cases 1 to 50 were considered ‘early experience’, whereas cases 51 and higher were considered as ‘late experience’ for statistical analysis. The rate of CJ and SNL was significantly higher after the early 50 cases (P < 0.05). In contrast, the rate of intraoperative transfusion, the median time of oral feeding initiated after operation, and the length of hospital stay was not different between the both groups (P > 0.05).ConclusionsIn this experience, improved perioperative and postoperative parameters for LKPE were observed in the last 50 patients when compared with the first 50 patients. The dedicated training is likely to contribute to significantly shorter learning curves in future adopters.

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“…Since the first case report of laparoscopic Kasai operation for biliary atresia by Esteves et al [11] in 2002, it has been performed in various countries [12,13]. However, postoperative liver prognosis is poorer following laparoscopic Kasai operation than following conventional laparotomy [12][13][14]. According to a meta-analysis by Lishuang et al [12], laparoscopic Kasai operation has not replaced open surgery.…”

Section: Discussionmentioning

confidence: 99%

Retrospective investigation about anesthetic management of biliary atresia in children: laparoscopic versus conventional Kasai portoenterostomy

Sato

Nishiwaki

2019

JA Clin Rep

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Purpose: Biliary atresia can be fatal if surgery is not performed early. Laparoscopic Kasai portoenterostomy was recently introduced in our hospital. Despite laparoscopic surgery generally provides advantages, there are few studies of laparoscopic surgery performed in infants. We retrospectively compared anesthesia management of patients undergoing laparoscopic Kasai portoenterostomy and conventional Kasai portoenterostomy and investigated anesthetic complications of laparoscopic Kasai portoenterostomy. Methods: Fifty-three biliary atresia patients who underwent surgery from April 2010 to September 2017 were assessed: 28 who underwent laparoscopy (L group) and 25 who underwent laparotomy (O group) were included. We compared body temperature, cases of hypothermia, the lowest mean blood pressure, bleeding volume, infusion volume and urine volume (ml/kg and ml/kg/h), age, weight, operation time, and the number of patients postoperatively admitted to the intensive care unit. Results: In the L group, volume of bleeding was significantly smaller, and the lowest body temperature was significantly lower in the L group than in the O group (22 ± 35.1 mL vs 70 ± 34.5 mL, respectively, P < 0.01; 35.6 ± 0.8°C vs 36.5 ± 0.4°C, respectively, P < 0.01). And severe hypothermia was significantly more in the L group (7 cases vs 0 cases P = 0.01). There was an inverse correlation between the lowest body temperature and anesthesia time (r = − 0.464, P < 0.01). Multiple linear regression analysis revealed that anesthesia time was a significant predictor of hypothermia. Conclusion: Our study revealed that laparoscopic surgery in infants reduced bleeding, but induced hypothermia and upper airway edema may be caused by relatively excessive infusion. At laparoscopic Kasai surgery, anesthesiologist is recommended to prevent hypothermia and need to pay attention to amount of infusion. Trial registration: This study was approved by the Ethics Committee of Nagoya University (2017-0290) and registered with the UMIN Clinical Trial Registry (UMIN000033158).

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A prospective study comparing laparoscopic and conventional Kasai portoenterostomy in children with biliary atresia

Cited by 41 publications

References 11 publications

Biliary atresia: Where do we stand now?

Biliary atresia: Where do we stand now?

Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases

Retrospective investigation about anesthetic management of biliary atresia in children: laparoscopic versus conventional Kasai portoenterostomy

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