Laparoscopic open Kasai portoenterostomy: our experience

Abstract

The question of feasibility of laparoscopic Kasai procedure for biliary atresia in infants has been a subject of discussion for a long time, and still remains unsolved. 110 children with different bile duct malformations were operated on in our clinic since 2000. The first laparoscopic Kasai portoenterostomy was performed in January, 2008 to a 2 month old child. Since then, laparoscopic Kasai portoenterostomies were performed in 42 children with biliary atresia. The age of the children varied from 50 days to 3.5 months. The mean weight of the patients was 4693±767g. 24 patients between the years 2000- 2008 were operated on by conventional (“open”) procedures. All procedures were performed with 4 to 5 trocars using 3 and 5-mm ports. Excision of the fibrous biliary remnant was performed laparoscopically in all cases. The Roux loop was fashioned outside of the abdominal cavity through the umbilical incision in 23 children, and in 18 infants the Ruox loop was performed laparoscopically. Laparoscopic biliary reconstruction was performed successfully in all patients. Results: 79% of children who underwent laparoscopic Kasai had a normal postoperative bilirubin level, whereas the other 9 children did not drain bile and required liver transplantation. In the “open” surgery group, 74% of patients had good results. The duration of laparoscopic Kasai procedure was significantly longer than open surgery (p < 0.05). There were no conversions. We observed significantly fewer complications (40%) after laparoscopic hepaticojejunostomy than after traditional hepaticojejunoduodenostomy (84.6%, p < 0.05). The average length of stay in the ICU, and the duration of analgesia after laparoscopy was significantly lower than after open surgery (p < 0.05). Cholangitis was found in 21.4% in the laparoscopic group and 25% in the open surgery group. Intraperitoneal adhesions in patients who underwent liver transplantation were less pronounced after laporoscopy, compared with open Kasai procedure. Conclusion: Our experience leads us to conclude that laparoscopic Kasai operations can be used as the procedure of choice in the treatment of children with biliary atresia.