Shirota C, Hinoki A, Tainaka T, Sumida W, Kinoshita F, Yokota K, Makita S, Amano H, Nakagawa Y, Uchida H. Laparoscopic Kasai portoenterostomy can be a standard surgical procedure for treatment of biliary atresia. World J Gastrointest Surg 2022; 14(1): 56-63 [PMID: 35126863 DOI: 10.4240/wjgs.v14.i1.56]
Corresponding Author of This Article
Hiroo Uchida, MD, PhD, Doctor, Professor, Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya 4668550, Aichi, Japan. hiro2013@med.nagoya-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chiyoe Shirota, Takahisa Tainaka, Wataru Sumida, Kazuki Yokota, Satoshi Makita, Hizuru Amano, Yoichi Nakagawa, Hiroo Uchida, Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya 4668550, Aichi, Japan
Akinari Hinoki, Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, Nagoya 4668550, Aichi, Japan
Fumie Kinoshita, Department of Advanced Medicine, Nagoya University Hospital, Nagoya 466-8560, Aichi, Japan
Author contributions: Shirota C, Tainaka T, Sumida W, Yokota K, and Makita S collected the patient data; Shirota C and Hinoki A analyzed patient images; Hinoki A and Nakagawa Y interpreted the patient data regarding operation; Kinoshita F analyzed the statistics; Shirota C and Uchida H were main contributors in writing the manuscript; and all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the (Nagoya University Hospital) Institutional Review Board (Approval No. 2020-0593).
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hiroo Uchida, MD, PhD, Doctor, Professor, Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya 4668550, Aichi, Japan. hiro2013@med.nagoya-u.ac.jp
Received: April 5, 2021 Peer-review started: April 5, 2021 First decision: July 3, 2021 Revised: July 31, 2021 Accepted: January 13, 2022 Article in press: January 13, 2022 Published online: January 27, 2022 Processing time: 288 Days and 23 Hours
Abstract
BACKGROUND
Biliary atresia (BA) is a rare pediatric disease.
AIM
To compare the outcomes of laparoscopic portoenterostomy (Lap-PE) with those of laparotomy (Open-PE) at a single institution.
METHODS
The surgical outcomes of PE were retrospectively analyzed for patients with a non-correctable type of BA from 2003 to 2020.
RESULTS
Throughout the assessment period, 119 patients received PE for BA treatment, including 66 Open-PE and 53 Lap-PE cases. Although the operation duration was longer (medians: for Open-PE, 242 min; for Lap-PE, 341 min; P < 0.001), blood loss was considerably less (medians: for Open-PE, 52 mL; for Lap-PE, 24 mL; P < 0.001) in the Lap-PE group than in the Open-PE group. The postoperative recovery of the Lap-PE group was more favorable; specifically, both times to resume oral intake and drain removal were significantly shorter in the Lap-PE group. Complete resolution of jaundice was observed in 45 Open-PE cases and 42 Lap-PE cases, with no statistically significant difference (P = 0.176). Native liver survival rates were >80% for both groups for the first half year post surgery, followed by a gradual decrease with time; there were no statistically significant differences in the native liver survival rates for any durations assessed.
Core Tip: The aim of this study was to compare the outcomes of laparoscopic portoenterostomy (Lap-PE) with those of laparotomy (Open-PE) at our single institution. Although the surgical operating time was longer, the lower blood loss and more favorable postsurgical recovery (shorter time to resume oral intake and time to drain removal as well as less postsurgical adhesion) were significant advantages of Lap-PE over Open-PE. There was no significant difference in native liver survival rates or short-term surgical outcomes between LapPE and OpenPE. Therefore, our study results support the efficacy of Lap-PE as a standard therapy.
