title: Laparoscopic versus conventional Kasai portoenterostomy does not facilitate subsequent liver transplantation in infants with biliary atresia.
abstract: OBJECTIVE
  The benefit of laparoscopic Kasai portoenterostomy remains controversial. With the progression of the disease, significant numbers of patients require liver transplantation. It has been reported that reduced internal scarring and fewer adhesions could facilitate the subsequent liver transplantation and thus represent a potential advantage of the laparoscopic technique.
  
  
  METHODS
  All patients undergoing liver transplantation in our hospital between 2006 to 2008 after a laparoscopic or conventional Kasai procedure were included in this retrospective analysis. Primary outcome measure was duration of liver explantation. Secondary outcome measures were total duration of transplantation, amount of blood transfusion, and need for reoperation within the first year.
  
  
  RESULTS
  In total, 19 patients were included: 11 patients after open Kasai and 8 patients after laparoscopic Kasai. There was no significant difference in patient characteristics. The mean duration of liver explantation was comparable in laparoscopic (125±8 minutes) and conventional (116±6 minutes) (P>.05) patients. Moreover, we did not identify any significant difference in the need for blood transfusions, total liver transplantation duration, and need for reoperation.
  
  
  CONCLUSIONS
  We did not detect any measurable benefit of laparoscopic compared with conventional portoenterostomy for subsequent liver transplantation. Thus, prevention of adhesion formation and facilitating subsequent liver transplantation are not rationales for laparoscopic Kasai portoenterostomy.
authors.affiliation: Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Oetzmann von Sochaczewski
authors.forename: Claus
authors.initials: C
authors.lastname: Petersen
authors.forename: Benno M
authors.initials: BM
authors.lastname: Ure
authors.forename: Alexander
authors.initials: A
authors.lastname: Osthaus
authors.forename: Kai-Peter
authors.initials: KP
authors.lastname: Schubert
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Frank
authors.initials: F
authors.lastname: Lehner
authors.forename: Joachim F
authors.initials: JF
authors.lastname: Kuebler
mesh_terms: D001656:Biliary Atresia / Q000601:surgery*; D001803:Blood Transfusion; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D011171:Portoenterostomy, Hepatic; D012086:Reoperation; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000517:prevention & control; D016896:Treatment Outcome