Multicenter, retrospective, comparative study of laparoscopic and open Kasai portoenterostomy in children with biliary atresia from Japanese high‐volume centers

Murase, Naruhiko; Hinoki, Akinari; Shirota, Chiyoe; Tomita, Hirofumi; Shimojima, Naoki; Sasaki, Hideyuki; Nio, Masaki; Tahara, Kazunori; Kanamori, Yutaka; Sato, Masato; Yamamoto, Hirotoshi; Sugawara, Yasuhiko; Hibi, Taizo; Ishimaru, Tetsuya; Kawashima, Hiroshi; Koga, Hiroyuki; Yamataka, Atsuyuki; Uchida, Hiroo

doi:10.1002/jhbp.594

Cited by 31 publications

(5 citation statements)

References 19 publications

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“…If PE fails to drain the bile, liver transplantation is the only means of survival for patients with BA. In Japan, 60% of patients with BA achieve postoperative decreases in serum bilirubin levels at 1 year of age [1]. The anicteric transplant-free survival rates at 5 and 20 years are approximately 60% and 50%, respectively [2].…”

Section: Introductionmentioning

confidence: 99%

Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation

et al. 2021

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Purpose This study aimed to investigate the negative effects of intestinal obstruction for jaundice-free native liver survival after Kasai portoenterostomy (PE) for biliary atresia (BA). Methods We retrospectively reviewed the records of patients who underwent PE for BA between 2006 and 2019. We evaluated the postoperative morbidity of intestinal obstruction for up to 2 years after PE and the effects of intestinal obstruction on jaundice-free native liver survival. On the basis of their initial operation, patients were divided into open portoenterostomy (Open-PE) and laparoscopic portoenterostomy (Lap-PE) groups, and morbidity was compared. Results Of the 87 patients reviewed, 6 (6.9%) patients developed postoperative intestinal obstruction and underwent surgery to relieve the obstruction. The morbidity of early postoperative intestinal obstruction was 1.68 per 10,000 person days. The jaundice-free native liver survival rate among patients who once achieved jaundice-free status after PE was significantly lower in the patients with intestinal obstruction compared to in those without intestinal obstruction (0% vs. 73.8%; RR = 3.81, p = 0.007). No significant differences were seen in postoperative intestinal obstructions between the Open-PE and Lap-PE groups (p = 0.242). Conclusions Intestinal obstruction negatively impact jaundice-free native liver survival, even in patients who once achieved jaundice-free status after PE for BA.

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Section: Introductionmentioning

confidence: 99%

Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation

et al. 2021

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“…Twenty-nine studies (1 RCT and 28 NRSs) dealt with four types of procedures, such as Kasai's portoenterostomy (1 RCT 191 and 13 NRSs 192 193 194 195 196 197 198 199 200 201 202 203 204 ), choledochal cyst resection (11 NRSs 192 205 206 207 208 209 210 211 212 213 214 ), cholecystectomy (3 NRSs 215 216 217 ), and hydatid liver cyst resection (1 NRS 218 ). The results are summarized in Table 4 .…”

Section: Resultsmentioning

confidence: 99%

“…Recently described advantages during the last decade were less cholangitis and pancreatitis after choledochal cyst resection, 195 less blood loss, 200 206 207 208 211 212 less reoperation rate, 206 less adhesion at liver transplant, 198 less pain postoperative, less clearance of jaudience, 198 and shorter operative time for laparoscopic resection of hydatid cyst of liver. 218…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies

et al. 2021

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Introduction Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There is still a call for well-founded evidence. We reviewed the literature on studies published in the last three decades and dealing with advantages and disadvantages of laparoscopy compared to open surgery. Materials and Methods Studies comparing laparoscopic versus open abdominal procedures in children were searched in PubMed/MEDLINE. Reports on upper and lower gastrointestinal as hepatobiliary surgery and on surgery of pancreas and spleen were included. Advantages and disadvantages of laparoscopic surgery were analyzed for different types of procedures. Complications were categorized using the Clavien–Dindo classification. Results A total of 239 studies dealing with 19 types of procedures and outcomes in 929,157 patients were analyzed. We identified 26 randomized controlled trials (10.8%) and 213 comparative studies (89.2%). The most frequently reported advantage of laparoscopy was shorter hospital stay in 60.4% of studies. Longer operative time was the most frequently reported disadvantage of laparoscopy in 52.7% of studies. Clavien–Dindo grade I to III complications (mild–moderate) were less frequently identified in laparoscopic compared to open procedures (80.3% of studies). Grade-IV complications (severe) were less frequently reported after laparoscopic versus open appendectomy for perforated appendicitis and more frequently after laparoscopic Kasai's portoenterostomy. We identified a decreased frequency of reporting on advantages after laparoscopy and increased reporting on disadvantages for all surgery types over the decades. Conclusion Laparoscopic compared with open pediatric surgery seems to be beneficial in most types of procedures. The number of randomized controlled trials (RCTs) remains limited. However, the number of reports on disadvantages increased during the past decades.

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“…Kasai portoenterostomy (KPE), which re-establishes bile flow and prolongs the survival of the native liver ( 4 , 5 ). The etiology of BA may be associated with immune dysregulation, inflammation, and virus infection, but it is still unclear ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Prognosis of Biliary Atresia Associated With Cytomegalovirus: A Meta-Analysis

Yan

Liu

et al. 2021

Front. Pediatr.

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Objective: The etiology of biliary atresia is unclear, but viral infection has been implicated. The aim of the current meta-analysis was to investigate relationships between cytomegalovirus (CMV) and the prognosis of biliary atresia.Methods: PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure database, and Wanfang Data electronic databases were searched for eligible studies. Each relevant text was thoroughly reviewed and examined, including related papers in their reference lists.Results: A total of nine studies including 784 patients were included in the analysis. Biliary atresia patients with CMV exhibited significantly lower jaundice clearance (odds ratio: 0.46, p < 0.0001; I2 = 15%, p = 0.31). There were no significant differences in the rates of cholangitis or native liver survival. CMV-pp65-positive biliary atresia patients had a significantly lower rate of jaundice clearance (odds ratio: 5.87, p = 0.003; I2 = 0%, p = 0.71) and a significantly higher rate of cholangitis (odds ratio: 0.21, p = 0.01; I2 = 0%, p = 0.43) than CMV antibody-positive biliary atresia patients.Conclusion: Biliary atresia patients who were also infected with CMV had a poorer prognosis, particularly with respect to jaundice clearance. CMV status may influence the prognosis of biliary atresia. Clinicians should be able to routinely identify the subset of biliary atresia patients who are also CMV-positive, in order to improve native liver survival.

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Multicenter, retrospective, comparative study of laparoscopic and open Kasai portoenterostomy in children with biliary atresia from Japanese high‐volume centers

Cited by 31 publications

References 19 publications

Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation

Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation

Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies

Prognosis of Biliary Atresia Associated With Cytomegalovirus: A Meta-Analysis

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